Coexisting Issues with Apraxia
“Pure” CAS is when no other speech, language, cognitive, or sensory issues coexist with the disorder. The professional literature states that “pure” CAS is very rare. A child with CAS may also present with other motor planning deficits. Limb apraxia refers to motor planning deficits relating to arms, legs, fingers, etc. Global apraxia refers to motor planning deficits with all of the above. Children with Apraxia can also be diagnosed with Autism Spectrum Disorder, Sensory Processing Disorder, ADD/ADHD, various genetic disorders, low tone, learning disabilities, cognitive disabilities, etc. The list can be endless.
We are lucky that with Cha-cha, his Apraxia is his primary diagnosis, however he is not considered "Pure" due to his Sensory Processing Disorder (under-responsive subtype) and hypotonia (low tone). These coexisting issues can interfere with treatment and the approach therapists take in treating the apraxia. With Cha-cha, it takes a lot to motivate him to practice and do his therapy. I remember his EI SLP coming in with a bags of new toys and games and he took one look at her and her bags, turned his head and said, "Ugh!" and walked away. Often in therapy, when things get overwhelming for him, he will turn to me for a squeeze or tight hug. We use to do brushing therapy, but we found that he didn't need it as much anymore, and we could do some jumps, running up and down the hallway, or tight squeezes instead to get his motor going. His SPD makes him quiet in nature and plays into social anxiety, so it's hard to get him to talk sometimes when he's feeling anxious. This typically happens in social gatherings where he's around a lot of unfamiliar people. We are lucky that he doesn't tantrum much - most of his upsets are over things that would upset most children, however he has things he doesn't like at all like hair washing, toe nails cut, wearing no socks, and brushing his hair.
Just today I had the honor of taking a tick off from him. This is not easy with any child, but with Cha-cha to talk sense into him that the cap full of "water" (rubbing alcohol) I was going to pour on his head wouldn't get into his nose, eyes, ears, or on his shirt, took about 10 minutes. I accidentally pulled some of his hair out of his head with the tweezers trying to get the tick out, and you would have thought I was torturing him. Tonight he pooped in his pants and needed a tubby. His immediate response, "Doe you haft-oo doe a air washin? Are dey bugs in de tubby?" (Do you have to do a hair washing? Are there bugs in the tubby?)...he gets over things pretty quickly, but I think this one is going to take a while. :( Most of this can be categorized as normal in any child, however it's hard to know if this is "normal" or "Cha-cha normal".
Any child is a puzzle, but when you throw in diagnoses, it puts more pieces to the puzzle and it just takes a little longer to figure out.