Congenital Ocular Motor Apraxia

Also known as: Cogan’s Apraxiae; Saccade Initiation Failure


The main feature of congenital ocular motor apraxia is an inability to make horizontal fast eye movements from birth. Fast eye movements are called saccades and are used to quickly change the direction that our eyes are looking in. In this condition, the child fails to start fast eye movements.

Congenital ocular motor apraxia is often not the only condition that the child may have. Children may also have:

  • learning difficulties (see entry Learning Disability)
  • delayed language development
  • delayed sitting and walking skills
  • delay in toilet training.


Medical text written March 1997 by Dr C Harris. Last reviewed May 2016 by Professor C Harris, Professor of Neuroscience, Plymouth University, Plymouth, UK.

What are the symptoms?

Infants may at first appear blind but later develop characteristic head movements to shift gaze (head thrusts). Typically the abnormal head movements subside as the child learns to make blinks to help move the eyes, which can make detection of the condition difficult in the older child. Most children with congenital ocular motor apraxia have few problems getting around. They can have problems with looking in a particular direction and following fast moving objects (such as following a ball in sport or watching cartoons on television).

Children may be hypotonic (floppy) with mild motor delay (behind in developing motor skills such as holding head up, rolling over). There may be some unsteadiness of movement called ataxia. Speech development may be slow requiring speech therapy, and reading problems may occur.

What are the causes?

Many different parts of the brain control eye movements. If any part becomes damaged then ocular motor apraxia may develop. A child may be born with these special eye movement control bits not working (congenital).

Other children may develop it in childhood (acquired). There are many different reasons why a child might develop ocular motor apraxia in childhood.

Very often no cause can be found. Doctors call this idiopathic.

How is it diagnosed?

Congenital ocular motor apraxia is often diagnosed by doctors asking parents questions about their child. Head thrusts are a typical movement that helps a child overcome their difficulty in moving their eyes quickly.

During an examination of the child’s eye movements an eye doctor can confirm the diagnosis.

A head scan can sometimes shows a certain part of the brain to be smaller than usual. This bit of the brain is called the vermis of the cerebellum, which helps the eyes make exact and quick movements. It is not known why some children might have a small vermis.

How is it treated?

The congenital condition is not progressive (does not get worse over time). How a child is affected throughout their will depend on the severity of the other associated problems in addition to the visual problems.

Management of the condition involves supporting the child and young person to reach their full potential. Supportive therapies like speech and language therapy, physiotherapy and occupational therapy will help a child. Special education support will help a child to adapt to learning at school.

Inheritance patterns and prenatal diagnosis

Inheritance patterns
Usually the condition is sporadic (occurring with no family history). In some families more than one child may be affected by the condition.

Prenatal diagnosis

Is there support?

COA Support Group


This is a self help group, established in 1996. It provides support by email but can offer support to parents without internet access. The group links families where possible, publishes a newsletter and has information available.

Group details last updated May 2016.

Back to A-Z Conditions