Q: My preschool client with apparent childhood apraxia is not willing to participate and often walks away from or gets annoyed with therapy plans and procedures. What should I do?

He sounds like most of the kids on my caseload. Childhood apraxia comes with its pure stubbornness at times. But I don’t think that “behavior” itself is always the issue. There is a reason for the stubborn behavior.

• What I usually see with preschool kids like this is that they are processing language like a much younger child – like an 18-to-24 month old child. That does not necessarily mean that he is “thinking” like a toddler. If he is becoming interested in the beginning basics of colors, numbers, shapes, sizes, alphabet, etc, then he probably is thinking (cognition, receptive language) like a peer or somewhere near there. Even so, he may be “processing” language like a toddler. I.e., he manipulates language and dialogues like a toddler.
• What does a toddler naturally do when someone is trying to get them to do something? And what happens when we try to get a toddler to attend to the things we want them to attend? Unless a toddler is captured by the item or activity we present, he usually refuses, ignores, selectively attends, walks away, responds with silence, tantrums, hits, etc. This is classic “terrible two” behavior — the behavior associated with learning to take control of communication and events.
• A typical toddler does not know how to participate in communication with the kind of sophistication we expect from preschooler (3-5 year old) children. And a preschool child with apraxia often responds in the same way, usually by simply refusing, not responding, or by talking about what they want to talk about regardless of what you say.
• A typically developing toddler will want to lead, not follow, activities. If you change your approach to therapy in order to allow the child to lead the dialogue, you will have much more success. If you structure your dialogue so that he is more the initiator and you are more the responder, he will love therapy and he will come to love you. You will become his favorite person with whom to interact, and he will say more to you than to anyone else in the world. Gradually you can take more control.

My book Becoming Verbal with Childhood Apraxia centers around this very topic. It discusses a framework for developing a stubborn young client’s interest in and willingness to communicate.

I have also discussed this topic in two one-hour DVD continuing education courses available called Stubborn & Uncooperative and The Four Stages of Imitation.