Apraxia and Stubbornness

By Pam Marshalla

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.

2 thoughts on “Apraxia and Stubbornness”

  1. This is the most important thing I’ve read regarding my 3 year old. Oh how I wish her therapists knew this. Thank you from the bottom of my heart. I hate that people think my little girl is a stubborn brat. She has so many things going on both medically and developmentally that we are just beginning to figure out. She was adopted from foster care 10 months ago so now we finally have medical and educational rights and are reading and getting her evaluated so that we can help her become her best.

  2. Our 9 year old granddaughter with Apraxia refuses to be polite or social with strange adults, even grandparents.. She refuses to be affectionate with her grandparents. She will obnoxiously. complain about a grandparent’s minor mannerisms utterly unnoticed by others. How should we handle this and is it common at her age?

    To encourage other parents dealing with Apraxia, we are otherwise blessed: she is in 3rd grade in regular classes. She is a grade behind but making A’s in everything but conduct and handwriting in a very good school. She is loved by her teachers. She has tutors and has taken outside motor skill classes She is very intelligent, interested (and opinionated) in the world. She has a good speech therapist at her school and her speech is very good.

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