Will She Outgrow It?
Sensory-based motor disorder is the second type of Sensory Processing Disorder. Children with sensory-based motor problems have trouble balancing, moving and performing unfamiliar tasks or activities, or a combination of these. There are two types of sensory-based motor disorder: dyspraxia and postural disorder. Dyspraxia is a motor planning disorder, while postural disorder affects the child’s muscle tone, posture, and stability. Some children with dyspraxia have postural disorder as well, and both disorders can result in motor coordination problems.
Motor planning is the ability to conceptualize, organize, and execute a plan to perform an unfamiliar motor task and to adapt in the moment of action around task demands.1 In other words, motor planning encompasses the generation of an idea, sequencing through the steps, and execution of the activity.
Once a new task is learned by a typical child, motor planning is a subconscious process, something that comes automatically. For children with dyspraxia, motor planning is a forced conscious process—one in which she must consciously think about the sequencing and execution of each step, and may perform the steps painfully slow, in the wrong order, or not at all. Children with dyspraxia have trouble getting their bodies to do what they want when they want. During play, they have trouble generating ideas on what to do and can’t sequence thoughts or actions so that they may execute them. To illustrate, consider the following scenario:
Billy is an active 2½-year-old toddler who demonstrates excellent motor planning skills. He began by propelling a big dump truck around the edge of the play space, making lots of truck sounds and loading his truck with smaller trucks, balls, and animals. Once the truck was full, he roared to the city dump (his mother’s lap) and unloaded his treasures. After a few minutes of this activity, he proceeded to build a road out of large blocks and raced his vehicles with glee in his make-believe speedway. Billy then pretended that each vehicle carried a circus animal as he had seen on television. Eventually, Billy pushed the cars and trucks down the pretend sidewalk at crashing speeds.
James, also a 2½-year-old, has dyspraxia. He found little to do with his vehicles. James watched Billy’s elaborate play but did not join him. Instead, he pushed his trucks back and forth in a straight path, spun the wheels with his finger, and lined them up in an orderly row. He did try to “drive” his truck on Billy’s road but he had difficulty keeping his truck on the road and kept tripping on and misplacing the blocks.
Some children with motor planning challenges have trouble learning the initial novel task, and once learned, can perform it routinely. Other children have difficulty getting feedback. Feedback is the mechanism through which our brains make constant adjustments when learning something new to master a task. Children with feedback problems have trouble completing a task no matter how many attempts.
The primary symptom of sensory-integrative based dyspraxia is motor planning deficits; motor coordination problems may or may not be present and are considered a byproduct of poor motor planning. The complex nature of motor planning relies on the efficient integration of sensory information and is different from motor coordination, or the ability to control body movements smoothly. Therefore, treatment for praxis revolves around occupational therapy with an emphasis on ideation and sequencing and treatment for pure motor execution problems is achieved with neuro-developmental therapy (NDT).2
When children with motor planning deficiencies do not exhibit motor coordination problems, their motor planning deficiencies usually go undetected, as parents write off their poor performance in sports and games as individual differences. In addition, children with normal motor coordination in the presence of motor planning difficulties can show surprising skill in performing motor activities that are familiar and well-rehearsed. The children who do have motor coordination problems in tandem with motor planning deficits demonstrate more tangible and concrete representations of their disorder. Parents of these children often express concerns to their pediatricians but are sometimes advised that children with coordination difficulties will outgrow them. Several studies have shown this not to be the case.3,4
The specific symptoms and severity of the disorder vary widely among affected children. Severely affected children have difficulty with all forms of motor planning and execution (some are unable to speak their entire lives), while other children may have subtle difficulties or can perform some motor tasks well and others poorly. Thus, it is helpful to think of developmental dyspraxia as a spectrum disorder; a child may fall on the continuum between mild and severe.
While praxis is learned, it also has a biological component because motor development is predetermined by innate biological factors that occur across all social, cultural, ethnic, and racial boundaries.5 Therefore, dyspraxia can be an inheritable trait and tends to run in families. The risk factors associated with dyspraxia include premature birth, difficult delivery, prenatal issues, and a family history of dyspraxia or other developmental conditions.6 The highest comorbidity rates exist with dyslexia at 30 to 50 percent and ADHD at 40 to 50 percent.7
Scientists do not know what causes dyspraxia but believe most cases may be caused by immature neuron development in the brain. It is theorized that the sensations that enter the brain do not have enough interconnected neural pathways on which to travel. In other words, sensations start traveling on the railroad tracks but run out of tracks. In a smaller number of cases, it is theorized that the neural pathways are appropriately placed, but the sensory information is not being transmitted properly. In other words, there are railroad tracks upon which the sensory information can travel, but some of the information falls off the tracks. Regardless of cause, the brain’s neural deficits result in processing problems in one or more sensory systems, which result in motor planning and/or motor execution challenges.
Typical problems associated with dyspraxia are:
Little to no interest in pretend play.
Doesn’t appear to know how to play with toys.
Has difficulty generating ideas.
Visually monitors their movements, (e.g., watching their feet when they run).
Problems with gross motor movements (running, jump roping, riding a bike, skating, playing on the playground).
Problems with fine motor movements (writing with a pencil, cutting with scissors, picking up small things).
Behavioral problems such as hyperactivity, attentional problems, emotional outbursts, aggression, elevated anxiety, irrational fears, low frustration tolerance, low self-esteem.
Social deficits such as avoiding social interactions, exhibiting an inability to form relationships with other children, trouble following back-and-forth social interactions, socially awkward. Trouble interpreting ambiguous social nuances.
Oral motor problems (speech and nonspeech).
May have visual-spatial problems resulting in bumping into other children or objects, avoid toys that require visual-spatial awareness such as Legos or puzzles, difficulties copying text from one place to another, demonstrate hand flapping or distal cupping.
The second sub-type of sensory-based motor disorder—postural disorder—renders controlling their bodies difficult to perform many motor tasks. Poor postural control typically involves difficulties with standing posture, inability to sustain postures such as sitting and standing, and balance8. These children will have low muscle tone, and their bodies will flop over when they try to sit for any period. Unlike dyspraxia, postural disorder will always result in clumsy movement.
Parents are usually the first to know that something isn’t quite right, a nagging feeling they can’t shake off. Parents shouldn’t hesitate to seek a developmental screening either through the early intervention program in their state, or through a private occupational therapist with advanced training in sensory processing disorder. See “What Now?” for information on how to locate an occupational therapist. With treatment, these children can often lead happy and successful lives! For further information on treatment, see my blog “What Now?”
Osten, Beth. Beth Osten & Associates, Skokie, IL, in discussion, February 2, 2015.
Ayres, Jean A. Sensory Integration and the Child. CA: Wester Psychological Services, 2005.
Losse, A. S.E. Henderson, D. Elliman, et.al. "Clumsiness in Children: Do They Grow Out of It? A 10-year Follow-Up Study." Developmental Medicine & Child Neuro”logy 33 no.1 (1991): 55-68.
Blondis, TA, JH Snow, NJ Roizen, KJ Opacich, and PJ Accardo. "Early Maturation of Motor-Delayed Children at School Age." Journal of Child Neurology 8 no.4 (1993): 323-9.
Gallahue, David L. Motor Ability in Children. New York: Wiley and Sons, 1985.
Miller, Lucy J. Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. 2nd ed. New York: Penguin Group, 2014.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, 2013.
Murray-Slutsky, Carolyn and Betty Paris. Exploring the Spectrum of Autism and Pervasive Developmental Disorders. Austin, TX: Hammill Institute on Disabilities, 2000.
Miller, Lucy J. A Sensible Approach to Sensory Processing Disorder: Overview of all Types. Video Course #1101, 1:10, SPD University.