Understanding Apraxia and Speech Delay: A Functional Medicine View of Motor Planning and Healing

As a parent, you’ve probably asked yourself: Why doesn’t my child say what they mean? Or why can they understand something, but not reliably do it?
These are often the questions that lead to the concept of apraxia—a challenge of motor planning and speech coordination rather than a lack of understanding.

Two of my favorite educators from the MAPS (Medical Academy of Pediatric Special Needs) program, Dr. Dana Johnson and Dr. Anju Usman Singh, have each contributed valuable insight into this area. Their work beautifully illustrates how both body and brain must be supported to help children overcome speech delays and motor planning challenges that may underlie apraxia.


What Is Apraxia (and How It Relates to Speech Delay)?

The word praxia comes from the Greek for doing, and “a-” means without. Apraxia describes difficulty planning and executing voluntary movements—even when comprehension and muscle strength are intact.

For many children, this shows up as speech delay or inconsistent verbal output. They may know what they want to say but can’t consistently get the words out. Others experience broader body-movement challenges that affect coordination, imitation, and daily tasks.

Apraxia is not simply a speech disorder—it’s a motor coordination issue that can influence every part of how a child expresses themselves and engages with the world.


Insights from Dr. Dana Johnson

Dr. Dana Johnson, PhD, MS, OTR/L is an occupational therapist and researcher based in Tampa, Florida. She specializes in motor planning, apraxia, and sensory-motor integration in children and adults who are non-speaking, minimally speaking, or inconsistently verbal.

Dr. Johnson’s work highlights that communication is not only cognitive—it’s motor-based. For many children with speech delay or limited expressive language, the challenge lies in the brain-body connection needed to initiate and sequence speech movements.

By supporting that connection through sensory integration, intentional movement, and motor-reliability work, she helps children build consistency and confidence in communication.

Her educational contributions through Documenting Hope and the MAPS community have helped countless clinicians and parents better understand how body-based support can unlock communication potential.


Insights from Dr. Anju Usman Singh

Dr. Anju Usman Singh, MD, FAAFP, ABIHM, FMAPS is the director of True Health Medical Center in Naperville, Illinois. A board-certified family and integrative medicine physician, she has been a pioneer in biomedical and functional approaches to autism, ADHD, apraxia, and speech delay.

Dr. Usman Singh’s work focuses on how underlying toxic load and nutritional deficiencies can interfere with neurological and motor development. Imbalances in zinc and copper, mitochondrial function, chronic infections, and environmental exposures can all impact how efficiently the brain and nervous system coordinate movement and speech.

Her research supports the idea that when the body’s detoxification, immune, and metabolic systems are overwhelmed—or when it lacks key nutrients—motor control and speech production can both be affected.


A Functional Medicine Framework for Speech and Motor Development

Through a functional medicine lens, we look at the underlying “terrain” of the body that influences brain-body communication. When speech delay or apraxia is present, there are often contributing factors that make it harder for the nervous system to function efficiently.

That exploration may include reducing toxic load from environmental chemicals, heavy metals, or infections that stress the nervous system; replenishing nutrients like zinc, magnesium, B vitamins, iron, and essential fats that support neurotransmission and motor coordination; and supporting gut health, mitochondrial energy, and detox pathways so the body can process and recover more effectively.

When the body’s foundation is strengthened, therapies that target speech and movement often become more effective—because the system they’re working on is more responsive.


What Progress Can Look Like

Progress often starts subtly. Parents might notice that transitions become smoother, gestures or attempts at speech appear more often, or their child seems more organized in movement. Over time, as toxic burden is reduced and deficiencies are corrected, speech and communication can begin to emerge or strengthen.

This isn’t about quick fixes—it’s about allowing the body’s natural capacity for healing to unfold. When we support the body and remove obstacles, the brain and nervous system often respond with new levels of clarity and coordination.


Bodies have a natural propensity toward healing. When we remove obstacles and offer the right kind of support, that built-in wisdom has room to do its work. This process isn’t about changing who your child is—it’s about creating the conditions where their strengths can shine.


Supporting speech and motor development through a functional, root-cause approach—helping parents understand the ‘whys’ behind apraxia and speech delay

References

Take the next small step toward your child’s healing.
Together, we can explore the whys behind your child’s speech and motor challenges, uncover possible contributing factors, and create a clear, supportive roadmap—visit-ready labs, smart questions for your clinician, and simple actions that fit real family life.

Leucovorin and Folate Pathways in Autism

(Why this therapy may help — and why it’s only one part of the whole picture)

Why Folate Matters for the Brain

Folate—also known as vitamin B9—is essential for brain development, neurotransmitter production, and detoxification. It supports processes like methylation and DNA repair that help the brain grow and function well.

But in some children on the autism spectrum, folate has trouble getting into the brain where it’s needed most. Even when blood tests show normal folate levels, the transport mechanism that moves folate across the blood–brain barrier can be blocked.

This is called Cerebral Folate Deficiency (CFD). Often, it’s linked to folate receptor alpha autoantibodies (FRAAs)—immune proteins that block the receptor responsible for carrying folate into the brain.

When this happens, kids may experience language delays, irritability, fatigue, or developmental plateaus that don’t improve with diet or therapy alone. In a functional medicine framework, this is one of many possible “root causes” we explore when progress feels stuck.


What Leucovorin Is—and How It Works

Leucovorin (folinic acid) is an active form of folate that can bypass the blocked receptor and still reach the brain.

While standard folic acid depends on the folate receptor α (FRα) to cross into the central nervous system, leucovorin uses an alternate pathway—the reduced folate carrier (RFC)—to deliver active folate directly to where it’s needed.

Once in the brain, leucovorin supports the same vital processes as natural folate: methylation, neurotransmitter balance, and mitochondrial function.

This is what makes it different from over-the-counter folic acid supplements. For children with FRAAs or other transport problems, leucovorin can sometimes “open a different door” and restore function that was otherwise blocked.


What Dr. Richard Frye’s Research Shows

Dr. Richard E. Frye, a pediatric neurologist and researcher, has published multiple studies exploring folate metabolism in autism. His work shows:

  • High rates of FRAA positivity (around 70 %) in children with autism.
  • Improved verbal communication and language development in FRAA-positive children treated with folinic acid.
  • Better social engagement and reduced irritability in several studies.
  • Dose-dependent effects: those with higher antibody levels often show stronger responses.
  • Good safety profile: side effects are generally mild and temporary (agitation, sleep changes, or headaches).

In other words, leucovorin appears to help when a clear folate-transport issue is identified—and when it’s introduced thoughtfully, as part of a broader plan.


Why It’s Not the Whole Picture

Folinic acid can make a big difference—but only if the rest of the system can support that change.

Folate metabolism is connected to everything from gut health to mitochondrial energy, detox pathways, and sleep. If those areas are still under strain, leucovorin alone may only move things partway.

Functional medicine focuses on strengthening these foundations so that targeted therapies like leucovorin can work more effectively.
That means also looking at:

  • A nutrient-dense, anti-inflammatory diet
  • A healthy gut and balanced microbiome
  • Adequate mitochondrial and detox support
  • Quality sleep and stress regulation
  • Coordinated supplement and medication routines

When these systems are supported, we tend to see steadier, longer-lasting improvements—speech that continues to build, behavior that stabilizes, and energy that feels more consistent.


Testing and Clinical Considerations

If a child’s history or symptoms suggest a possible folate-transport issue, a physician can order FRAA testing (and sometimes tests for soluble folate-binding proteins).

When results confirm an issue, leucovorin may be prescribed under medical supervision. Doses vary, but all studies emphasize close monitoring and gradual introduction.

Families should never start this on their own. It’s best used as part of a coordinated plan with a clinician who understands neurometabolic or functional medicine approaches.


A Functional Medicine Lens

In functional medicine, we rarely look for a single “answer.”
We look for patterns—nutrient pathways that need support, inflammation that needs calming, and systems that need connection.

Leucovorin can be a powerful tool for some children, especially those with confirmed folate receptor antibodies, but it’s one piece of a much larger puzzle. When we zoom out and build a foundation that supports methylation, detox, sleep, and digestion, the body can finally use these targeted interventions the way they’re intended.


Your Family’s Roadmap to Healing

If you’ve heard about leucovorin or FRAA testing and aren’t sure if it fits your child’s picture, I can help you sort through it.
Together, we can:

  • Understand what testing might be appropriate
  • Prepare visit-ready labs and questions for your clinician
  • Translate complex recommendations into clear, doable steps
  • Build the foundations that make biomedical interventions more effective

You don’t have to figure this out alone.
Step by step, we can build a roadmap that helps your child’s body work better—so therapies like leucovorin can make the difference they’re meant to.

Leucovorin (folinic acid) can bypass a blocked folate receptor to support folate transport into the brain — an important step in addressing cerebral folate deficiency seen in some children with autism.

References:

  1. Frye R.E. et al. Folinic acid improves verbal communication in children with autism spectrum disorder and language impairment: a randomized double-blind placebo-controlled trial. Mol Psychiatry (2016)
  2. Rossignol D.A., Frye R.E. Folinic acid in autism spectrum disorder: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry (2021)
  3. Frye R.E. et al. Biomarker associations and clinical response to folinic acid in autism spectrum disorder. Front Neurosci (2024)