Autism and clumsiness

This answer is by occupational therapist Alison Wheeland, a University of Southern California doctoral student completing her residency with Autism Speaks.

Our 10-year-old son has high-functioning autism. He really wants to play with other kids at recess but has a hard time catching and kicking balls. We tried soccer to improve his skills. But he comes home angry because he keeps missing that ball. Is his clumsiness just a part of his autism, or is there something we can do to help?

That sounds so frustrating for your son!  You’re right that clumsiness is a common symptom of autism. But there are ways to help.

From what you describe, it’s possible that your son is struggling with dyspraxia. “Praxis” is the three-part process of figuring out what you want to do (ideation) and how to make your body do it (motor planning) and then performing the action (execution).

Dyspraxia involves difficulty with one or more of these steps.

Many people with dyspraxia have trouble learning physical skills such as kicking a ball. They may likewise struggle with everyday tasks that require coordination. For example, putting on clothes and tying shoes. A tendency to bump into or trip over things? That can be dyspraxia, too. It’s also common for children with dyspraxia to avoid playing with new toys because they can’t figure out how.

Dyspraxia and autism

Why is dyspraxia common in people with autism? Dyspraxia is related to problems with sensory processing. And sensory difficulties are among autism’s core symptoms. When your sensory system isn’t working properly, your body doesn’t get the feedback it needs from the environment. This feedback is what helps your body sense what to do and how to do it.

Dyspraxia and your senses

Research suggests that dyspraxia is related to problems with the following senses in particular:

• Tactile. This is your sense of touch. It includes light touch, deep pressure, pain, temperature and vibration. Many people who have difficulty with tactile processing tend to drop things, bump into things and knock things over without realizing it. They may be unaware when there’s food on their faces or their clothing is crooked.
• Proprioception. This is your sense of your body’s position in space. Recall what it’s like to have your leg fall asleep. You can still walk, but you have to look at your leg to tell where it is. In a sense, that’s an extreme form of dyspraxia. More typical examples of proprioception difficulty include squeezing a paper cup too hard or pressing down too hard or too lightly with a pencil. It also takes proprioception to copy a movement – like kicking a ball – that someone has just demonstrated for you.
• Vestibular. This is your sense of balance and movement. Your vestibular sense helps you counterbalance when you start to tip. So poor balance and posture can be signs of a problem in this area.
• Visual. People with dyspraxia often use their sight to compensate for difficulty processing the above senses. To illustrate, imagine cutting a circle of paper. You’d expect to get feedback from a variety of senses. You feel how far you’ve rotated the paper as you cut it. You feel the angle of the scissors in your hands. But individuals with dyspraxia may depend on their eyes to tell whether they’re cutting in the right place. To get a feel for what I mean, try cutting out a circle while someone else is holding and moving the paper!

Overcoming dyspraxia

Occupational therapy focuses on helping people participate in life’s important activities. And it certainly sounds like being able to play with his friends is a really important “occupation” for your son.

To address dyspraxia, many occupational therapists use a sensory integration approach. In short, sensory integration is a physically active therapy that can improve sensory functioning. The sensory integration approach uses fun and motivating activities that engage multiple senses. It’s the therapist’s job to adapt the intensity and amount of sensory input to just the right level for each person. (For more information, see my previous blog post: “Sensory Integration: Changing the Brain through Play.”)

This approach may help your son gain a better sense of his body and what’s around him. A good occupational therapist will carefully increase the difficulty of activities to challenge his posture and the timing, precision and force of his movements.

For example: Your son might first learn to line up his foot to kick the ball, then time his kick with a moving ball and then aim the ball at a target.

If your son has trouble problem-solving his way through certain movements, the OT can focus on the “ideation” and “motor planning” steps of the process. She’ll help your son come up with ways to use his body and interact with objects. This might include making an obstacle course and figuring out how to get through it. The next step might be kicking a ball through the obstacle course!

What improvements might you see over the course of days, weeks and months? You may see your son moving with more awareness, coordination, attention or organization. As a consequence, he may feel less anxious and frustrated. You may also see improvements in self-confidence, social participation and learning. Since everyone with dyspraxia is unique, your child’s symptoms, therapy and outcomes will be highly personal.

Finding treatment

If your son has an Individualized Education Plan at school, you can ask that he be evaluated for occupational therapy services with someone skilled in sensory integration work. I also suggest seeing if occupational therapy is covered under your health insurance. If so, your son’s primary-care doctor could provide a referral. A helpful resource for finding occupational therapists in your area is the Autism Speaks Resource Guide.

Good luck to your son in his endeavors on the soccer field and on the playground!