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brick and mortar.valerie dejean with alfred a tomatis
(Pictured: left: Former Spectrum Center Brick and Mortar office in Manhattan. Right: Valerie Dejean with Alfred A. Tomatis at his villa in Spain (1997))

Dyspraxia in children with Autism and PDD Dyspraxia in Autism and PDD Valerie Dejean writes on Vestibular Dysfunction early gross and Fine-motor Development in Autism (FDA) is consistent with expected early developmental milestones by Valerie Dejean (1-845 915-3288)

Here, early gross and fine motor development is consistent with expected early developmental milestones. Difficulties may appear with more complex motor behavior, such as climbing a jungle gym or nesting cubes. Use of utensils may present a problem and manipulative tasks such as doing and undoing buttons and zippers may prove impossible. There are however, children who present with advanced motor skills. These are the children who climb everywhere without apparent judgment (though they never get hurt). They are also the children who figure out how to operate the VCR or the computer at age two. As it is often the case in Autism/PDD, certain areas of development may excel while others lag way behind (such as language).

Motor planning disorder, known as Dyspraxia is common in children with Autism/PDD, though it is infrequently recognized. Motor planning or "praxis" is the ability of the brain to conceive, organize, and carry out a sequence of unfamiliar actions. Praxis enables us to deal with the physical environment in an adaptive manner. In Dyspraxic Syndrome there is a reduced ability to carry out non-learned movements, even though adequate physical and conceptual capacity exists.

Praxis is believed to be a single function involving three basic processes: ideation - generating an idea of how one might interact with the environment; motor planning - organizing a program of action; and execution - the actual performance of a motor act.

Difficulties in praxis are often the cause of the increased sense of frustration that the Autistic/PDD child experiences during his second year of life. Rather than just experience the world, the child is now called upon to master it. Toys become increasingly complex, requiring more sequenced behaviors than the child with Dyspraxia can organize. Self-care activities require increasingly longer sequences of movements. Speech also becomes more challenging, requiring a more complex sequence of oral motor movements. Language itself is heavily dependent on the ability to organize and sequence. As life becomes increasingly complex the child with Dyspraxia hits major road blocks in his development.

According to the Swiss psychologist Jean Piaget, the child moves from the sensory-motor period to the pre-operational period during the second year of life. For this transition to occur successfully the child must first master the ability to imitate. In a typically developing child we take for granted the ability to imitate. Imitation is essential for the development of praxis. Difficulties with praxis and motor planning problems affect a child's ability to learn through imitation. They cannot learn through actions demonstrated to them and much of early childhood learning is done in this manner. Children with praxis disorders may be able to generate their own plan but cannot follow someone else's. They may seem uncooperative, as they cannot perform on demand, (usually for an examiner), tasks their families have seen them do on other occasions. They don't know how to fit in because they don't fundamentally learn in the same manner.

Integration of sensory information (which sound stimulation can profoundly influence) gives our brain the capacity to learn. It gives us the ability to put together the foundations necessary for more abstract concepts. For Example, this integration allows us to perceive red, round, hard, and then develop the concept of apple. This gives the foundation to recognize a picture of an apple. We can then latter recognize and connect the symbols A P P L E to mean apple. We can later become even more abstract and understand the expression "you are the apple of my eye."

Praxis provides the foundation that enables the child to internally represent objects and events and thus acts as a bridge between non-symbolic and symbolic thought. The ability to play with toys symbolically is certainly largely absent or severely limited in autistic and PDD children. They have no internal representation and therefore cannot use external symbols. Many children with Autism/PDD cannot make the symbolic leap to such abstraction. They are trapped in a lower level of development. They can spin the wheels on a car, yet they cannot pretend to make the car go down the road. This blocks the ability to develop normal cognitive and linguistic structures such as "Make the car go fast/slow, over/under etc." Their ability to perform may have no proportional relationship with their cognitive level, which often is quite intelligent. This again can be a cause for significant frustration and low self-esteem.

Auditory Processing Disorders in children with Autism and PDD

The auditory system needs to interpret all the sounds of spoken language and attach linguistic meaning to them. For example a dog is able to hear as well or better than humans, however the dogs' ear isn't able to separate the speech stream into meaningful words that he can understand. This requires auditory perception and auditory processing; together they provide the foundation for understanding language. Most children with Autism/PDD have significant auditory processing disorders, and this fact alone contributes significantly to their language delays.

Our ability to analyze sound starts to develop in the womb and makes rapid progress during the first two years of life. In the womb the fetus is learning language largely from hearing his mother's voice. The baby first learns to tune into salient sounds and ignore background noise. During this stage he learns to recognize all the sounds (phonemes) that make up language. With an ear already attuned in listening to language sounds, the baby is ready at birth to make rapid progress in attaching meaning to the sounds he hears. .

The ability to analyze sounds accurately and rapidly is crucial to language development. The baby's ear must recognize the blend of the sounds " U and P" to mean the action of rising. He must do this rapidly in order to listen to the rest of the sentence, which may ask him to "stand up" or to "pick up the toy". Children with Autism/PDD have difficulty in multiple areas of auditory processing, including tuning in to the primary message while ignoring background noise, as well as accurately and rapidly analyzing sound. If these processes are not working accurately it is very difficult for children with Autism and PDD to develop language..