Does your child seem to understand what you’re asking but still struggle to follow through with actions like standing up, walking to you, or picking something up? If so, the issue may not be comprehension or behavior—it could be whole-body apraxia. This is common, but not discussed among children with autism, Down syndrome, and other developmental delays.
Often misunderstood or overlooked, whole-body apraxia is a neuromotor disorder that disrupts the ability to carry out voluntary, purposeful movements. This blog will help you understand what it is, why it’s under-recognized, and how to better support your child if they are affected.
Defining Whole-Body Apraxia: More Than Just Motor Delay
Whole-body apraxia is a condition in which a person’s brain cannot effectively send signals to the body to perform movements, even when they know what they want to do. This disconnect between intention and action is what some professionals refer to as a brain-body disconnect.
It’s not a problem of understanding or willingness—it’s about the pathway between cognition and motion not working as it should. Children with this condition often appear uncoordinated, unresponsive to verbal cues, or resistant to instructions, but in reality, they may be trying very hard to move—and simply can’t.
Why Whole-Body Apraxia Goes Undetected
You may have heard of apraxia of speech, especially if your child has worked with a speech-language pathologist (SLP). In those cases, the focus is on speech production and motor planning of the mouth and face.
Whole-body apraxia, by contrast, involves motor planning throughout the entire body, and it is often underdiagnosed—particularly in pediatric developmental settings.
Even as a trained occupational therapist, I initially didn’t use the term “whole-body apraxia” in my assessments. Instead, I described symptoms as fine or gross motor delays, which are accurate but fail to capture the full scope of what’s really happening.
Why the oversight? One major reason is that many professionals still struggle to presume competence. When a child fails to carry out an action after being given a direction, it’s often assumed they didn’t understand. But with whole-body apraxia, they often do understand—they just can’t physically initiate or coordinate the movement.
How Motor Planning Works—and Where It Breaks Down
To better understand whole-body apraxia, it’s important to first understand praxis, or motor planning. Praxis is the brain’s ability to conceive, plan, and carry out a sequence of movements.
From infancy, motor planning helps babies learn to roll, sit, crawl, walk, and manipulate objects. A child might see a toy across the room, and their brain has to:
- Form the idea to get the toy.
- Plan the movements.
- Adjust as they go to successfully reach it.
This process is typically seamless in neurotypical development. But for children with neuromotor conditions like autism or Down syndrome, these pathways may be disrupted. The result is difficulty with motor coordination—even if the child knows exactly what they want to do.
Early Red Flags Parents Might Notice
Many children with whole-body apraxia show signs early on, though they’re not always recognized as such. Parents might notice that their child:
- Isn’t meeting motor milestones like crawling or walking on time
- Struggles with transitions or following multi-step directions
- Appears to “shut down” when asked to do something physical
- Has speech delays or limited spontaneous language
- Moves in unusual, inconsistent, or inefficient ways
These signs are often interpreted as developmental delay or behavioral resistance, when in fact they may point to an underlying motor planning disorder.
Can Whole-Body Apraxia Be Outgrown?
Apraxia doesn’t typically go away, but children and adults can make significant progress with the right support. Apraxia also presents along a spectrum. Some individuals may have minimal speech but can move with some coordination. Others may be nonspeaking and have significant motor challenges that affect everyday functioning.
Several key factors can influence how apraxia shows up and how well someone can progress:
1. Physical Health & Medical Conditions
Underlying health issues—especially gastrointestinal problems or inflammation—can interfere with intentional movement. When the body is in discomfort, it’s harder to focus on controlling motor output. Ensuring that these underlying medical conditions are looked after is essential to support motor planning.
2. Vision and Motor Integration
Another major factor is functional vision. Not to be confused with visual clarity (acuity), functional vision refers to how the brain processes visual information. If visual input is distorted or misprocessed, motor coordination is likely to be affected as well. I often refer families to developmental optometry when I suspect this may be contributing to apraxic symptoms.
What Support Looks Like for Apraxia
Supporting someone with whole-body apraxia starts with shifting our assumptions. It’s critical to understand that:
- The individual likely understands you.
- They are not being defiant or lazy.
- They want to respond, but can’t do it easily—or at all—without help.
This is why apraxia is so challenging for both the person and their family. It affects communication, movement, behavior, and self-confidence.
So, what can you do?
1. Break It Down
Instructions like “Go put on your shoes” involve multiple motor steps. For someone with apraxia, this command is too complex. Instead, break it into tiny, manageable chunks:
- Get your eyes on your shoes.
- Walk your body to your shoes.
- Bend your knees, push your hips back to sit in the chair.
- Reach for the shoes.
- Bring your foot to your shoe, etc..
Each of these steps may need to be coached and supported.
2. Coach the Motor
“Coaching the motor” means guiding the individual through the initiation of movement, step-by-step, and helping them follow through. You may need to physically model the action or use visual prompts. Think of it as helping the brain and body connect in real time. Also, you can schedule a virtual session with one of our Occupational Therapists for help with motor coaching.
3. Presume Competence
Always assume that your child understands far more than they can express. This principle is especially important when working with nonspeaking children or those with limited expressive language. Believing in their capacity helps build trust and opens the door for growth.
Looking Beyond Behavior: A Neuromotor Lens
When children with whole-body apraxia struggle to comply with instructions, it’s easy to assume the issue is behavioral. But this doesn’t tell the full story.
Ask yourself:
- Could this be a motor initiation issue?
- Does my child need the steps broken down and for me to coach them? (The answer is “yes”, but the way!)
- Is the environment overwhelming, making it difficult to regulate?
- Could pain or fatigue be interfering?
By evaluating behavior through a neuromotor lens, we can provide more targeted support.
Building Confidence Through Understanding
Whole-body apraxia is real, common, and profoundly misunderstood. But when parents, therapists, and educators understand how it works, we can create strategies that empower children rather than frustrate them.
With the right interventions—including intentional movement coaching, visual support, sensory accommodations, and validation—children with apraxia can achieve more independence, better communication, and higher self-esteem.
Final Thoughts for Parents
If you suspect your child may have whole-body apraxia, trust your instincts. Seek out professionals who presume competence and understand motor planning, functional vision, and sensory-motor integration. Early, informed intervention can make a world of difference.
Most importantly, never underestimate your child’s understanding or potential. With the right tools and support, they can build the pathways they need—one step at a time.
