Autism, Apraxia and the Oboe

I can’t play the oboe. I probably never will. But, if I wanted to, it would probably take, like, 6 months just to be able to produce a single note. Then, maybe after 1 year – if I practiced every day – I might be able to play Three Blind Mice. Poorly.

My brain did not come preprogrammed with instructions about the correct embouchure to play a double-reed instrument (or any wind instrument, for that matter). So, I would have to practice that movement of my lips. My lungs were never used to delivering short blasts to fine-tune output. I would have to practice that, also. Then, I would have to figure out some way to combine a number of physical feats at the same time in order to deliver that first squeak.

It wouldn’t matter how many times my teacher told me to play a song. It wouldn’t matter if she raised her voice and implored me to do a better job. Perhaps a different teacher would get me more motivated? I might get frustrated with my lack of ability and stop trying for a while. I could start making horrible sounds just to make something come out, and then the teacher would say that I’m not trying or I’m doing it wrong. Instructors would become very disappointed if I started to bang on surfaces with the oboe – just to make any sound come out.

That is exactly how it must feel for children with ASD who cannot speak. When a neuro-typical infant starts to babble and imitate words, it is because they already have human speech hard-wired into their cerebral cortex. Toddlers don’t think about, or really even practice speaking. It just comes.

Think how much more work it takes for a young child to let the caretaker know that they want juice, if they cannot speak. Infants simply cry and the parent offers a variety of choices until they hit on the correct one. Later, certain cries indicate a desire for food, not a toy. Without speech, a child pulls the adult to the refrigerator or opens it himself in order to communicate his wishes. We are all lazy. It would be much easier to do it the way the typically-developing sibling does… “JUICE” or “Juice, please” or “Mommy, I want juice!” The parent who says “I know he can speak ’cause he does it when he wants to,” is missing the point. That is what makes the child normal – we all do what we can when we want to, to the extent that our abilities allow. The ASD child speaks when he absolutely must, and then only when every circuit is working correctly.

Likewise, for an autistic child to speak more, pathways need to be laid down so that the activity can take place as part of a much more complex social environment and therefore more often and (hopefully) appropriately. Then, the electricity has to flow so that the circuit is completed and results in the correct sequence of events. It takes practice, desire, and an ideal set of circumstances. Many times, parents report that their child said some complex combination of words and ask, “Where did he/she learn that?” Well, they are apraxic, not deaf.

By getting the child in the best physical condition, the routes can be laid down. By supplying enough cellular energy, the circuits fire. By supplying S&L, OT and ABA, the child gets to practice. Parent’s love and encouragement supplies the desire to try. That takes a great deal of work by all parties involved.

I will never play the oboe, but, thankfully, the majority of ASD patients eventually speak (in practice, the number is even higher because of the younger age of diagnosis and appropriate interventions). Of course, that is just one part of their complex story. The goal is not to play solo, but to be part of a symphony.

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8 Responses to “Autism, Apraxia and the Oboe”

  1. My son Chembe is now 15 years he was diagonised with AUTISM at the age of 9. Even then the doctors did not know what was wrong with him. I went from hospital to hospital until I read from the internet about AUTISM. It has been a rough and long experience. sometimes you even want to ask God WHY the innocent child. He has excellent hearing but cannot utter a word except for TATA and bubling through some words when Gospel music is playing. Here in Zambia we dont have a SPEECH THERAPY CLINIC which the doctors recommended. Imagine they said with SPEECH THERAPY THE BOY CAN TALK WITHIN ONE MONTH. What can a poor widow like me do to find a speech therapy centre for my son? He is such an intelligent and handsome boy who can easily learn some skills but alas God knows what is in store for him as the disease is not very common in Zambia every one treats him like an outcast. I came to learn that he has AUTISIM from the internet. Doctors kept assuring me that he will speak until now he is 15 years old!

    He goes to a school for children with learning disabilities whose teachers are not tained to handle AUTISTIC CASES. I have tried to see relevant authorities to at least train 2 teachers to handle AUTISTIC CHILDREN but in vain. AUTISM IS NOT KNOWN HERE IN ZAMBIA HENCE THERE IS NOTHING THAT THE GOVERNMENT IS DOING ABOUT IT. PLEASE HELP ME AND MY SON GET TO A SPEECH THERAPY CENTRE!

    • Dr. Udell says:

      Oy vay… well, I have starting meeting doctors from all over the world who ARE more knowledgeable and interested in helping. There is a meeting next month iin Orlando, and I shall tell others about your plight.

  2. YG says:

    I’ve been curious though as to why our daughter speaks to the TV but will not communicate to us. By this I mean, she will answer Dora’s/Mickey’s questions “which way should we go, right or left?”…”right!!” and almost clearly sing their songs but will never express verbally any needs or wants: I want juice, I’m tired, this hurts. She will express these not verbally by pulling us where she wants or for example bringing over the empty juice cup, but she will talk to the cartoon. Furthermore, if I ask her a question using the same tone of the cartoon, I have a better chance of getting a response than if I just use my normal voice.

    • Dr. Udell says:

      It seems to me that you are describing the processing issue… how the child perceives and responds is how she is presently wired. The good news is that ‘generalization’ should be able to take place, so that she speaks to real people instead. I have often thought that this unusual way of learning could be used to assist education (instead of trying to ‘fix’ it).
      Thanks for your feedback.

  3. joseph gautier says:

    Great analogy Doc. Helps me to understand apraxia better.

  4. Lisa Martin says:


    I am an oboist and have played professionally for about 30 years. We have suspected our 17 year old daughter has been on the Autism spectrum her whole life but never got her formally diagnosed. I have several colleagues who play the oboe who also have children on the Autism spectrum. I started thinking about this a few days ago and wondered if playing the oboe could have caused this. We also have a nephew with Aspergers so I thought it may be genetic. I am just curious if there might be an underlying pathology that may have been caused by the oboe-playing. I hope not, but I guess if there is a risk, I would like to let other young players know.

    Thank you,
    Lisa Martin

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