All About Praxis: Part 2 of 2

by Affect Autism

This Week’s Guests and Part 1 Review

Occupational Therapist, Joann Fleckenstein, and Licensed Professional Counselor, Mike Fields, both of Individual and Team Therapy Services in Atlanta and Expert Developmental, Individual differences, Relationship-based (DIR) Trainers are back to dive further into praxis. If you missed the last podcast, be sure to check it out before listening to today’s Questions and Answers! We talked about what praxis is. Joann talked about how she tests a client’s motor planning including testing different affect states and using games to see in real time how a child does everything they need to do.

We talked about how Praxis is the thinking part, not the memory part, which means that praxis is unique and that once you show someone an idea and they repeat it, they’re now working from memory, which is a different part of the brain.  We asked how do we teach someone to find a new way and to be flexible? How do we teach them to repair? Mike told us you can harness curiosity and anticipation, but you cannot teach someone praxis nor make someone be curious. We can join them in their interests because those are things they’ll be more curious about, especially when they’re frustrated, and especially if they’re connected in a Relationship.

We discussed how we can understand, support and foster natural curiosity so our kids can be ‘thinkers’ and not just ‘doers’. We want to create opportunities for them to be curious. They have to be interested. We talked about why it’s so important if you can’t turn ideas around in your mind because there’s no negotiation nor flexibility you’ll be constricted at the fourth Functional Emotional Developmental Capacity (FEDC 4) and how everything builds on the foundational capacities. So let’s dive in and discuss more with Joann and Mike!


Bonus Insights

Challenges to Parents Supporting Praxis

We talked in Part 1 about how hard it can be for parents to facilitate praxis by not solving a problem for our child. Mike had mentioned that it’s more about how we feel if our child fails. It’s about our anxiety. But when things don’t go as expected, you can’t control it and that’s what praxis is all about. So to review what praxis is, I read from Occupational Therapist, Julie Hogg‘s recent Newsflash from the Interdisciplinary Council on Development and Learning:

  • To support ideation, we can wonder and follow the child’s lead, and support the expanding of thought.
  • To support organization, we create opportunities for reciprocity which then lead towards extended sequences, and expands into our environment and our actions.
  • To support initiation, we create an environment with our affect and our awareness that gives the gift of initiation back to our clients.
  • To support execution, we join, model and assist to create opportunities for and support the success of the development of new skills.
  • To support feedback, we use our relationship and to support regulation as we work together to problem solve!

Joann says that when we have a child with a diagnosis who has fallen off the developmental track, we want to catch them up, and the way we know how to do that is to teach. We mean to help, but in doing so, she says we rob our children of the opportunity of ‘learning to learn’. When she homeschooled her children for six months during the Pandemic, Joann realized quickly that neither of her children knew how to learn. They hadn’t developed the capacity to ask the questions. If they didn’t know the answer, their solution was, “I don’t know the answer. You have to teach me.

There was no curiosity to look up another source, Joann continues. She sat in her own discomfort and supported them in their discomfort of not knowing the answer. In supporting them, they developed the capacity to make a learning plan where they could get the information they were looking for. This gets to the heart of praxis, Mike emphasizes, because when we are uncomfortable, it’s a fear of not being able to predict what’s next. Praxis helps us recognize a pattern, which makes our brain think it’s safe. If it’s unpredictable, our brain prepares for fight or flight to protect us. 

We try to escape the discomfort like it’s a bad thing, Mike says. Hope is important from a mental health perspective, Mike continues. Even when you’re uncomfortable and afraid (because nobody’s perfect and bad things happen), you want to have a seed of knowing that the unknown holds potential and a growth opportunity. Fear is supposed to motivate us to do something. It can be an adaptive response, Mike explains. But in that fear, we can rob the potential from that moment, he says. Experience is the best teacher, even when it can be expensive because it doesn’t work out the first few tries.

Staying in the Moment of Not Knowing

Affect is the foundation for everything, Mike states. We have a desire to engage and connect, Mike explains. We talk about the ‘just-right’ challenge in Floortime where an individual bumps into this discomfort, not knowing how it will turn out. The parent or practitioner is there to support the individual. You can’t always solve the problem, but if you can stay in that moment, there is so much potential. Don’t run from that, Mike urges. We need some tension to move forward, Joann says, without purposefully dysregulating your child–which we would never do. But can we stretch

Joann asks if we can be a bit uncomfortable to learn how to navigate our world? As the parent, Joann will try to stretch to see if the child can stretch. If there’s a block in Occupational Therapy, Joann says, it’s usually an emotional block, so she’ll refer to Mental Health in order to examine that resistance to discomfort. I asked Joann, though, as a parent, how do we sit in our discomfort? The first thing for ‘how’, Joann says, is to get our own therapy. 

Parenting a neurodivergent child is a very different lived experience and we need to understand our own thinking and constrictions in our own capacities so we are available for our own children, without tapping out. I referred listeners to the recent podcast on parenting styles, where we talked about how, under stress, we can be more authoritarian or permissive than we’d ideally like to be.

Mike says that we don’t even have to create problems because the world makes sure we run into problems all the time. I gave the example that my son got an insect bite recently and I can’t solve that! In Floortime, Mike explains, when these problems come up–and they’re going to, how can we take advantage of those opportunities? Supporting somebody has to start with yourself, Mike says. 

Floortime isn’t about changing the person we serve; it’s about changing yourself to support them, so they can have those opportunities and be safe and connected in those experiences so they can struggle, fail, and succeed with us. Everybody can’t afford a coach, but you can come to ICDL’s free parent support meetings, or find another parent, friend, or trusted family member to get feedback from. Just having that ‘not feeling alone’ support is so helpful, Mike assures.

Parent Q & A

How do I best support my child who has problems with idea formation? Maybe they have an idea but just can’t express it? Maybe they are having trouble visualizing their idea?

When Joann works with an individual who has trouble coming up with an idea, she wonders if it is that they don’t have a mind’s eye for ideas? Is it that they are too dysregulated or feeling too uncomfortable in their own skin for ideas to come? You have to look at the ‘why’, she says. It might be because they don’t have the ability to come up with the mental idea. These are the kids who only can have ideas based on what they can see or hear; the kids who see the thing, play with it, and repeat, Joann explains. 

Joann says she might clear the room of clutter and put out two or three options for an activity. If the child rejects all three, then she’ll choose something else. By limiting the items, she gives them what they can handle. If a child doesn’t have a strong capacity 5 meaning that they are still very concrete, we have to have the actual items there in front of them, she explains. She starts from there. She can use pictures. It depends where they are at developmentally, she says.

For kids who can have ideas, but who can’t communicate them, it’s about finding a really good speech therapist who can help you find the ‘why’. Is it that they can’t organize the ideas in their brain, or that they aren’t coming up with the ideas in the first place? Really work at Capacities 1, 2, and 3, Joann urges, to expand communication, which is an expansion of ideas. Working at Capacities 1, 2, and 3, you’ll naturally see pieces of Capacity 4, where that praxis explosion happens and starts to develop, Joann offers.

A parent asked about their child’s motor planning difficulties. What is a praxis issue, how can you improve it, and how can you measure progress (like with handwriting or potty training, etc.)? Can not doing something be a praxis issue or is it anxiety?

Joann said that motor planning is a piece of praxis when it involves motor skills, such as when we’re using praxis for a motor idea like figuring out how to get from one place to another. Praxis develops with primitive reflexes as babies shift from moving as a reflex to moving intentionally, she continued. She said a clinician will take people back to motor skills to lay the neurological groundwork for praxis.

It’s easier for everyone to see praxis when it’s motor. She added that not doing something or inaction can be a praxis issue. Praxis involves having an idea, making a plan, executing the plan, and getting feedback on if the plan worked. We can get stuck if the plan doesn’t work. Some kids will suffer in silence because they don’t know how to initiate how to do something they need to do.

Praxis is how we do everything that we haven’t practiced, Joann said. It’s everything novel and different, or not how you expect. Joann will start from a motor perspective and make it as complex as she can in order to support the wiring for social praxis. An individual will have a problem, but doesn’t know how to go about asking for help to solve it. Praxis is one of those Individual differences that runs all through development. It’s part of how we turn ideas around in our head, and is implemented in Executive Function.

You can have a child who can run, jump, and climb, Joann continued, but if you take them to a new park or something changes, they can’t function when there’s a novel sequence. Praxis is how you navigate anything new. Many clients with dyspraxia are nationally-ranked soccer and tennis players, gymnasts, and child actors, Joann shared. Child actors do beautifully, she said, when they have scripted lines to read. They can do step-by-step instructions, but can’t make their own instructions. It’s the ability to understand the sequencing of doing this, and then this, before you do that.

Another parent asked if it is a praxis issue if your child grabs your hand to get something? The parent has also seen the child grab things himself.

Joann says that this is early praxis where the child realizes he needs assistance. He knows what he wants and is using the parent’s hand as a tool. It might be that he saw the parent reach for the object before so he now knows that the parent can get it for him.

Does praxis affect speech, and if yes, how?

Joann says yes, there is a diagnosis called Aapraxia of speech for children who struggle to co-ordinate the muscles of their mouth to say a word on command. They can’t say a word on command, but if in a situation that emotionally requires them to say the word, it comes out. For language, you can have challenges with your praxis of language. What that tends to look like is not being able to repair communication.

Some clients use the exact same words and expect her to understand after she didn’t understand the first time. They can see she didn’t understand, but they’re unable to change the structure to make her understand. The kids she sees who have motor challenges with praxis will often also struggle with speech and language.

On that topic, I asked about our kids who ask the same questions over and over again and how when we had Speech Therapist, Bridget Palmer, as our guest, she said that Temple Grandin has said that she used to ask her mother the same question over and over because she loved hearing her mother’s response.

Joann says that this is an anxiety response. There’s some great information and literature coming out on the link between dyspraxia and anxiety. It must be so frustrating for someone who struggles with praxis when something doesn’t go as planned because they can’t come up with a new idea, or a plan B. So there’s a lot of anxiety and energy spent on making sure that everything is as predictable as possible. This could be related to praxis. It could also be wanting to connect with someone, but not knowing how to say something new, so they repeat the same thing again and again. If you can’t think of another way to interact, you’ll just keep doing the same thing over and over.

Joann says that sometimes she’ll miss praxis challenges in the first couple of sessions because a child will come in and play, but by the third session if they’re playing with the exact same things everytime and not trying anything new, she’ll try to introduce something new and see the distress.

A parent asked for clarification about primitive reflex integration laying the groundwork for praxis.

Joann says that it depends on the child and what they can tolerate. If they can’t tolerate some primitive reflex integration, she’ll try to integrate them in more practical activities. In terms of laying the groundwork, it’s about offering opportunities for the child to sit in ‘not knowing’ and trying to find another plan. Sit beside them in their discomfort while they struggle to find another way. We want to offer them the opportunity to think through the activity.

Another parent asked if potty training can be a praxis issue.

Joann says that initially, yes, it can be all new sequences and get your pelvic floor to relax, but if you’ve been practicing with the same toilet and same timing, it could be more to do with the pelvic floor and interoception. Anytime something is practiced, it’s not praxis. So for the essentials like getting dressed, going to the toilet, etc. we practice over and over, but for praxis we’ll use non-essential skills to create opportunities to think.

Another parent asked if dyspraxia and Developmental Coordination Disorder (DCD) the same?

Joann says that to her understanding, they’re the same thing and usually it depends on where you are in the world.

Another parent described how their child requests to play basketball downstairs at their apartment complex, but when they get there, he’ll just play with opening and closing the door. They’ll remind him that they came to play basketball but he’ll say no, and he just wants to play with the doors. They’ll say that they’re not playing with the doors, so what does he want to do? He says he wants to go back home. When they get back to the apartment, he requests to play basketball again.

Joann responded that she wonders if ‘basketball’ to him means that he wants to play with the doors. The parents replied that he will see other kids playing basketball from the apartment window and requests to play, so he is making that connection. Joann replied that maybe it’s that he is getting stuck along the way when he’s distracted by the doors where he’s not able to get past the doors because he has to complete this ‘ritual’ type sequence of opening and closing the doors. This causes him to lose his energy and intention and has to return home to ‘reset’. Joann suggested one of them going downstairs first and opening the door first to see if he goes in without the distraction of having to open the door. She’s had other autistics tell her that they may have wanted to go to do something, but when they arrive, it’s not what they expected so they get stuck.

Another parent is curious to know more about Apraxia of speech. Her son can say a few words and sometimes he says things clearly, but then he can’t say it again. He uses sign language to communicate. How else can this parent work on it?

Joann says this is a more specific speech question and suggests looking up a speech therapist who specializes in Apraxia of speech. Other ways to support your children is to lay the groundwork with the motor piece, which is the thinking groundwork such as the toy he wants to play with not being where it’s supposed to be and wondering how to find it.

Someone asked if you can help adults with praxis.

Joann said that yes, you can work on it, and gave an example to begin. She had a client whose father was struggling to not just teach the child how to do something and gave the child the hint. Joann realized that opportunity was missed so tried something different and saw the challenge again with both the child and the parent. We, as parents, have to be available for the challenge, Joann says, of sitting with the child in frustration and the discomfort of not knowing.

If you’re not available, or in a rush, it’s not the time, Joann says. When you do have the time and opportunity, then you sit with the child. You can give the child information and say, “How in the world are you going to make this work? There’s got to be a way!” without giving the child a solution. If the child gets really frustrated you can give the child an idea without giving the entire answer. If the child cannot handle it, you can move on to something else and work on it another day.

I shared that you can do little things each day to help your children develop this thinking muscle. You can put your child’s socks on their hands and wait to see if they do anything about it, or tell you it goes on their foot. You can put their pants on your head and see what they do. I shared that my son would grab them off my head and protest.

I shared how my son and I listen to songs on his Spotify playlist on the way to school and one day I put up the lyrics to the song we were listening to and he lost it. He did not want to see the lyrics! He wanted to see the picture that goes with the song. I asked Joann what to do?

She said that in that moment you can let it go and later, come back and say that you noticed they really did not like that and say that you wish you knew why. That’s dropping the seed of an idea, she says. She loves to sprinkle seeds and see what sprouts by saying things like, “Hmm, that’s interesting“, without a demand to respond, and walking away so they get a glimpse of what’s in her brain.

Joann says that her own praxis has improved in helping others work on their own praxis. As we parent, we grow in our capacities and in our developmental skills. You can never go wrong sticking to the developmental path of the Functional Emotional Developmental Capacities (FEDCs). If the child is mostly playing at Capacity 3, then we deal with praxis at reciprocity. Can you roll this ball back and forth? Can you hide your body under a blanket?

In adults, she says they’ll use a lot of compensatory strategies such as the therapist K.C. Davis who has ways to keep yourself organized. Joann uses her lists to organize her weekend. If you can’t organize, you can get disorganized and anxious, so she’ll create the lists together with adult clients. This will give them the bandwidth to then work on other things. So with adults, Joann will use a combination of compensatory strategies along with working on strengthening the capacities. For individuals who melt down, Joann will offer choices and eventually gradually reduce the support required.

How does handwriting relate to praxis?

Joann says that motor planning is complicated because it’s not isolated from sensory experiences and everything else. This is about the feedback piece of “Is this accurate?” If you can’t adapt your plan and can’t see that if I just continue this same motor plan and it won’t work, then any time the paper is different, or the angle of the paper is different, or you use a crayon instead of a pencil, then you won’t be able to carry out the motor plan.

You can’t really target writing at that point. You target ‘targeting’ and getting good feedback. Throw a ball back and forth. Can they see an object coming and adapt to catch it? She might start with putting colour on paper. For adolescent clients that they have, they’ll do tape art with water colours but the visual motor demand and planning is limited. They’re just trying to accurately target a location with a pencil to get precision. It’s a lack of precision due to not getting feedback from praxis.

What about a child who can’t put on their own socks?

Joann says that maybe you can get them to put one pair of socks on consistently from practice, but as soon as the sock changes, it gets harder. Everything has to be exactly the same. Can they target their foot accurately? Can they open the sock? Can they stretch it and target? We need enough capacity to have therapeutic wiggle room to work on these skills so they have the tolerance to work on that skill, Joann continues. So she might wait on handwriting and just work on visual motor activities based on the child’s interests and affinities. Before a child is ready to sit and tolerate getting it wrong, it’s hard to get any traction.

The challenge is not that he can’t put the sock on. It’s that he can’t sit in the discomfort of not being able to put the sock on. If we give him enough stability and enough capacity to sit in that discomfort, then he will sit and practice putting his sock on. He will tolerate us saying, “Let’s try again!“.

Joann Fleckenstein, DIR Occupational Therapist

Joann says that she will stretch and hold the sock and let the child put their foot in, then she will let go, so the child has to pull it up over the ankle. I referred to the podcast with DIR Occupational Therapist, Keith Landherr, who talked about what parents see versus what they’re working on. He says they’re working on the precursors to that.

Another parent asked about children who can’t wipe their own bum.

It’s tricky, Joann says, because you can’t see it! If you’re relying on vision, because your proprioception isn’t good since you don’t know where your bottom is compared to where you put your hand. Sometimes having a mirror so they can see themselves helps. Until a child is ready to be able to try, you can get a toilet seat bidet that cleans you right up as you learn to wipe.

With the proprioception and the tactile system, if you can’t tell what’s happening without seeing what you’re doing, you can’t do it. Joann will sometimes wrap a child’s hand like a glove with toilet paper, then once they’re done, you put the ‘poopy glove’ into the toilet. Some kids do well with cold wipes which alerts the tactile system so you can feel it. It is child dependent and dependent on what they will tolerate. I referred listeners to the toileting podcasts I did with DIR Occupational Therapist, Alysha Paiaro.

Joann says that Praxis is the groundwork for Executive Function. How are you going to organize your day? To learn more about Joann, please see our podcast Floortime Lifestyle.

This week’s PRACTICE TIP:

This week let’s focus on ourselves and our own constrictions. 

For example: Consider what makes it so difficult for us to sit in the discomfort of waiting for our child to initiate. What makes it difficult for us to allow our child to figure something out for themselves? Talk to a trusted friend, fellow parent, coach, or therapist to figure out how we can make ourselves fully available for our children regularly for periods of time.

Thank you to Joann and Mike for taking the time to dive in to praxis deeper, and for Joann for the parent support meeting Q & A! I hope that you learned something valuable and will share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. 

Until next time, here’s to choosing play and experiencing joy everyday!

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