While identification and treatment of praxis is well understood by most occupational therapists trained in sensory integration, understanding the ideational aspect of praxis typically remains elusive. Identifying ideational difficulties and distinguishing them from motor planning problems can be difficult. May-Benson and Cermak (2007) developed the Test of Ideational Praxis (TIP) to address this problem. Research on the TIP led May-Benson (2006, April) to propose that as many as 50% of children with praxis difficulties demonstrate impaired ideations abilities. Children with ideational difficulties demonstrate a number of characteristics which aide in their identification. They demonstrate difficulties in areas of functioning including motor skills and affordance recognition, language use related to action, behavioral regulation, cognitive/executive function skills and play skills. They routinely have difficulty generating goals for actions and some idea of how to get there. They demonstrate a limited repertoire of motor actions and play themes and have difficulty playing alone. Children with ideation problems tend not to know what to do with new objects or toys, thus they often use all objects in the same way (e.g. bangs) and may use inappropriate actions on objects (e.g. stands on a ball). They may demonstrate the same range of actions as typical peers and children with motor planning problems but demonstrate a decreased frequency, variety and complexity of object interactions which results in a higher frequency of simple actions which do not require much object manipulation (May-Benson, 2006, April). Children with ideational problems have a decreased ability to alter plans or adapt objects from their usual use and are notoriously rigid about changes in routines. These children often develop unworkable plans and may need excessive time to generate ideas for action resulting in a decreased flow of ideas. As a result, these children often require increased reinforcement or encouragement to complete tasks. Memory can also appear to be problematic for these children as they often have difficulty remembering previous games they have played.
Children with ideational problems, while often scoring within average limits on language assessments, appear to have particular difficulty with the functional use of language related to actions and objects. These children demonstrate difficulty labeling properties of objects, their own body actions, and body/object movements in space. They are often very concrete in their language and do not use or tolerate representational language (e.g. a bolster swing cannot be a car). This lack of representational language contributes to the appearance of a lack of imagination or difficulty pretending. This impacts play skills as they have a restricted repertoire of imaginary play themes that are often re-enactments of specific stories or movies.
Ideational deficits are a cognitive difficulty that appears to have its basis in poor sensory-motor exploratory play. However, providing effective intervention for ideational difficulties may be difficult for therapists as these problems do not seem to respond well to traditional sensory integration-based activities alone. Therefore, directed cognitive interventions techniques are needed to effectively treat this area of dysfunction. The author has addressed ideational difficulties for over fifteen years and developed an intervention approach for ideation. The proposed intervention approach involves language-based strategies grounded in cognitive learning theory implemented within the context of a sensory and praxis rich environment. This approach consists of two types of intervention strategies: general strategies to promote ideation and a specific structured combined cognitive-motor approach to address ideational deficits. To learn more about assessment of and intervention for ideational problems, attend my courses Advanced Assessment for Praxis: Tools for Busy Therapists and Advanced Intervention for Ideation: Affordances to Executive Function. Also watch my website www.tmbeducation.com for more information on sensory integration, ideation and praxis.
May-Benson, T. A. (2001). A theoretical model of ideation. In E. Blanche, R. Schaaf, & S.Smith Roley (Eds.), Understanding the nature of sensory integration with diverse populations. San Antonio, TX: Therapy Skill Builders.
May-Benson, T.A. (2006, April). Ideation, language, cognition and behavior in praxis. Lecture Presented at Children’s Learning Forum, Ohio State University, Columbus, OH.
May-Benson, T. A., & Cermak, S. A. (2007). Development of an assessment for ideational praxis. Am J Occup Ther, 61(2), 148-153. Retrieved from PM:17436836