Relationship between motor skill impairment and severity in children with Asperger syndrome

doi:10.1016/j.rasd.2006.12.003

Research in Autism Spectrum Disorders

Volume 1, Issue 4, October–December 2007, Pages 339-349

https://doi.org/10.1016/j.rasd.2006.12.003 Get rights and content

Abstract

This study examined the correlation between severity and motor impairment in children with Asperger syndrome (AS). Children, ages 6–12 with AS (N = 51) and a control group of typical children (N = 56), were assessed using the Social Responsiveness Scale (SRS) and the Movement Assessment Battery For Children (MABC). A bivariate correlational design was used to compare the scores (Spearman rank correlational coefficient). Significant differences were seen between typical, mild to moderate and severe categories of SRS scores, based on the Kruskal–Wallis one-way analysis of variance by ranks (p < .05). Strong correlations were found between the MABC motor impairment levels and the SRS severity levels. This study adds a clearer understanding of the relationship between motor impairment and severity for children with AS. The degree of correlation indicates that motor skill impairment is a function of severity within AS.

Introduction

Motor skill impairment has been examined in numerous studies of children with Asperger Syndrome (AS). Delayed motor milestones and motor clumsiness are listed in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10; World Health Organization, 1992) as associated, but not necessarily diagnostic features of AS, while the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) does not include any type of motor problem in the diagnosis. Motor skill impairments have been found in 50–100% of participants in previous studies (Ghazuiddin & Butler, 1998; Ghazuiddin, Butler, Tsai, & Ghazuiddin, 1994; Gillberg, 1998, Green et al., 2002; Klin, Volkmar, Ciccetti, & Rourke, 1995). While occupational and physical therapists frequently address these motor problems in their interventions for children with AS, no study has investigated the relationship between motor impairment and severity with these children. Using a recently developed assessment of autistic impairment severity, the Social Responsiveness Scale (SRS, Constantino & Gruber, 2005), with the widely used Movement Assessment Battery for Children (MABC, Henderson & Sugden, 1992), we sought to examine the relationship between these characteristics of children with AS.

Section snippets

Literature review

Diagnostic criteria for AS include impaired social interaction; restricted, repetitive, and stereotyped patterns of behavior, interests, and activities; and lack of delay in language or cognitive development. AS is a diagnostic category under the larger group of Pervasive Developmental Disorders (PDD) in the ICD-10 (WHO, 1992) and is known as Asperger's disorder in the DSM-IV-TR (APA, 2000). The United States Department of Health and Human Services, Centers for Disease Control and Prevention (

Research design and methodology

This study used a bivariate correlational research design (Spearman rank correlational coefficient). It examined the relationship between severity levels and motor impairment levels in children between age 6 and 12 in two groups, those diagnosed with AS and a control group. Descriptive statistics were used to describe the motor impairment levels and severity. Research procedures to assure the safety and privacy of the subjects and to prevent unnecessary risk for them were included as part of

Results

Analysis included examination of means and standard deviations of scores for overall motor skills impairment levels, manual dexterity impairment levels, ball skills impairment levels, and static and dynamic balance impairment levels of the subjects with AS. Overall impairment scores consisted of 65% in the category of definite impairment, 25% with borderline impairment, and the remaining 10% with no impairment. All control group subjects were in the no impairment category. Impairment levels in

Discussion

Eighty-nine percent of the subjects with AS scored at least one standard deviation below the norm in overall motor skills. Sixty-five percent scored below the fifth percentile (two standard deviations below the norm) on the MABC, which would qualify them as having the comorbid condition of SDD-MF (Spagna et al., 2000). The motor skill results were generally consistent with other studies of motor skills in children with AS (Ghazuiddin & Butler, 1998; Ghazuiddin et al., 1994, Gillberg, 1989,

Acknowledgements

The authors are thankful to Kate Graver, Jessica Reinken, Andrea Runzi, Mary Crouch, and Nicolle Drew for their tireless commitment to the completion of the data collection. They would like to thank Betty Schaefer, Cathy Crouch, Valerie Harbolovic; Sonia O’Donnell, Lynda Cordry, Tami Morrissey, Deb Dolan, Barb Eckels, Nancy Vanderweile Milligan, Jackie Kilburn, Lois Ehrhard, Joan Smith, Tina Kreummel, Nancy Buchholz, Lori Thompson, Marla Johnson, and Lou Pruitt for their help in finding

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A thorough literature search was conducted for studies published from 2000 to 2023 on the motor skills of children with ASD using standardized motor assessments, followed by screening and data extraction.
A total of 22 studies were included in the review. With respect to the administration of standardized tests, six studies did not report on accommodations, five studies indicated no use of accommodations, and 11 studies used a variety of accommodations (visuals, repeated demonstrations, etc.). Large effect sizes obtained from 18 out of the total 22 studies indicated poor overall, gross, and fine motor skills of children with ASD compared to typically developing (TD) peers. With respect to prevalence, only eight studies reported on the prevalence of motor impairments in the ASD sample with values ranging from 16% to 88% of ASD sample. Similarly, only eight studies reported on specific motor domains/subtests impaired in children with ASD such as balance, ball skills, manual dexterity, and strength.
Although there is significant evidence for the presence of motor deficits in children with ASD, there is still uncertainty related to the prevalence, nature, and specificity of motor deficits, largely attributed to the variability in the study samples and designs.
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An individual with autism spectrum disorder (ASD) has social skill, motor skill, and motion perception deficits. However, the relationship among them was not clarified. Therefore, this study aimed to evaluate the effects of motor skills on social skills and motion perception.
Five typically developed children and fourteen children with ASD participated in our study. The N200 component, a brain activity indicating motion perception, was induced in mid-temporal (MT/V5) brain area by watching a random dot kinematograph, and was recorded using a scalp electroencephalogram. Furthermore, the social responsiveness scale (SRS) indicating the social skill deficit, the developmental coordination disorder questionnaire (DCDQ) estimating the developmental coordination disorder (DCD), and the movement assessment battery for children second edition (MABC-2) indicating motor skills were recorded in the children with ASD. A hierarchical multiple regression analysis was conducted to examine the modulation effects of motor skills on the relationship between social skills and motion perception. The dependent variable was the N200 latency, and the independent variables were SRS, MABC-2, and combined MABC-2 and SRS.
The N200 latency was more delayed in children with ASD relative that in typically developed children. Intact balance ability modulated the relationship between social skills and N200 latency in children with ASD. Within the high balance ability, when the social skills worsened, the N200 latency was shortened.
This is the first report that intact motor skills could modulate the relationship between social skills and motion perception.
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Among the 43 that used the BOT, 19 (44%) used the short version (BOT-SF) or a combination of BOT-SF and selected subtests. The complementary part of the M-ABC, the Motor Competence Checklist (MCC), was used in two studies, one for participants with ASD (Belaire et al., 2020) and as the sole component of the motor assessment for the control group in the other (Hilton et al., 2007). The qualitative observational part of the tool was not reported.
This scoping review identified methodological parameters affecting evaluation when administering standardized motor assessment tools among children with autism spectrum disorder (ASD).
PubMed, CINAHL, PsycINFO, Scopus, ERIC and Web of Science were searched for English-language articles published 1/1990–8/2022. Studies of children with ASD, 3–18-years old, using performance-based standardized motor assessment tools, were included. ASD sample characteristics, enrollment criteria, accommodations and missing motor outcome data were synthesized.
Among 5,432 references, 180 studies using 11 assessments were included. The most frequently used tools were the Movement Assessment Battery for Children, Bruininks-Oseretsky Test of Motor Proficiency and the Test of Gross Motor Development. Large-scale studies were lacking, and girls underrepresented. Low cognitive level was an exclusion criterion explicitly or as a related criterion in 87 (48%) studies. Behavioral issues were noted anecdotally. Methodological detail varied, particularly regarding missing data, administrators’ professions, training and inter-rater reliability. Seventy-four studies reported a total of 197 accommodations, related mainly to modifications of the tasks, accommodations to the testing procedure and changes in the physical setting in which the test was conducted.
The findings, building on previous reports, indicate that children and adolescents with ASD cannot be approached uniformly over the entire spectrum of intelligence (IQ) and behavioral profiles in motor assessments. Administration challenges may stem from ASD characteristics beyond cognitive ability. Inconsistency relating to the IQ variable and incomplete methodological reports continue to be obstacles to comparative conclusions. ASD-specific versions of the tools with a supplementary report, describing cooperation, off-task behaviors and engagement, and combining several tools are recommended. This review could inform development of guidelines regarding motor assessments for children with ASD.
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The former approach, which is also referred to as norm-referenced assessment, measures the outcome of performance (e.g., time taken to complete a task, number of successful trials completed, or number of errors made), whereas the latter, also known as criterion-referenced assessment, focuses mainly on the technique used to perform a particular movement skill (e.g., whether or not the child extends his/her arms to catch a ball) (for details of these assessment batteries, see Appendix A). Both product and process-oriented assessment batteries have been found to adequately capture the multifaceted nature of FMS and are considered to be highly reliable in distinguishing the movement skills performance between children with and without FMS impairments (for review see Cools, De Martelaer, Samaey, & Andries, 2011; Wiart & Darrah, 2001; Yoon, Scott, Hill, Levitt, & Lambert, 2006), resulting in their use in several studies examining FMS in children with ASD (Berkeley, Zittel, Pitney, & Nichols, 2001; Breslin & Rudisill, 2011; Ghaziuddin & Butler, 1998; Green et al., 2002, 2009; Hauck & Dewey, 2001; Hilton et al., 2007; Iwanaga, Kawasaki, & Tsuchida, 2000; Jasmin et al., 2009; Landa & Garrett-Mayer, 2006; Liu, Hamilton, Davis, & ElGarhy, 2014; Liu, Breslin, & ElGarhy, 2017; Lloyd, MacDonald, & Lord, 2013; MacDonald et al., 2014; Mache & Todd, 2016; Matson, Mahan, Fodstad, Hess, & Neal, 2010; Pan, Tsai, & Chu, 2009; Paquet, Olliac, Bouvard, Golse, & Vaivre-Douret, 2016; Provost, Lopez, & Heimerl, 2006; Provost, Heimerl, & Lopez, 2007; Staples & Reid, 2010; Van Waelvelde, Oostra, Dewitte, Van Den Broeck, & Jongmans, 2010; Whyatt & Craig, 2012; Zachor, Ilanit, & Itzchak, 2010). The current systematic review aims to summarize and interpret the above studies in order to have a deeper understanding of actual performance of fundamental movement skills in children with ASD.
Fundamental movement skills (FMS) are basic movement skills (i.e. balance, object control, and locomotor skills) that form the foundation for more advanced movement patterns. These skills are a crucial but often an overlooked part of the development process, especially in populations with autism spectrum disorder (ASD). In view of this, the present review was undertaken with the purpose of determining the extent of FMS impairments in children with ASD compared to typically developing children and those with other developmental disorders.
A total of 24 studies that measured FMS in children with ASD using product- and process-oriented standardized movement assessment batteries were included in the review.
The results showed that impairments in FMS are highly prevalent across the ASD spectrum and that children with ASD exhibited greater impairments in FMS competencies especially object control and locomotor skills compared to typically developing children and those with other developmental disorders. Moreover, these impairments in FMS appear to emerge early in life and persist throughout late childhood years in the majority of children with ASD.
These findings provide preliminary evidence suggesting that FMS has the potential to be an early motor marker in children with ASD, and that practitioners should therefore be encouraged to consider movement skill evaluations as a routine investigation for children with ASD.
Views of professionals about the educational needs of children with neurodevelopmental disorders
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Professionals play a key role in supporting children with special educational needs in schools. However, the views of those working with neurodevelopmental disorders are less known.
This study examined the views of professionals (including teachers, teaching assistants, educational psychologists, speech and language therapists, physio and occupational therapists etc.) working with children with Williams Syndrome (WS), Down Syndrome (DS) or with Autism Spectrum Disorders (ASD) in terms of how informed professionals are about the disorder and their views about the type of support these children need to be receiving.
Professionals working with 77 children with ASD, 26 with DS and 38 with WS completed an online questionnaire.
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Although professionals have a lot of knowledge about the specific neurodevelopmental disorders, further evidence-based training would allow more effective support for children with neurodevelopmental disorders in the classroom but also equip professionals better and raise their confidence in meeting these children’s needs.
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Gait and its associations with prewalking motor milestones, motor skills, and age were investigated in 32 children with infantile/atypical autism and 36 typically developing controls. Gait was assessed using GAITRite recordings of spatiotemporal and variability gait parameters. Parents reported their child's prewalking motor milestones. Motor skills were assessed using the Movement Assessment Battery for Children. Children with infantile/atypical autism showed higher gait variability than controls, indicating a less regular walking pattern. In children with infantile/atypical autism gait variability was negatively associated with motor skills, but there was no such association with prewalking motor milestones. The higher gait variability in children with infantile/atypical autism showed an age-dependent decrease, suggesting that their gait regularity converges toward that of typically developing children.

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^☆: This study was started as part of the dissertation research completed by the first author in the pursuit of her doctor of philosophy degree in occupational therapy.

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Relationship between motor skill impairment and severity in children with Asperger syndrome☆

Abstract

Introduction

Section snippets

Literature review

Research design and methodology

Results

Discussion

Acknowledgements

Research in Autism Spectrum Disorders

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of the American Academy of Child Psychiatry

Autistic personality disorders in childhood

Archiv fur Psychiatrie und Nervenkrankheiten

Bruininks Oseretsky test of motor proficiency

Pervasive developmental disorders in preschool children: Confirmation of high prevalence

American Journal of Psychiatry

Social responsiveness scale

Validation of a brief quantitative measure of autistic traits: Comparison of the Social Responsiveness Scale with the Autism Diagnostic Interview-Revised

Journal of Autism and Developmental Disorders

Autistic traits in the general population: A twin study

Archives of General Psychiatry

Identifying developmental coordination disorder: Consistency between tests

Physical & Occupational Therapy in Pediatrics

Reliability and concurrent validity of the movement assessment battery for children

Perceptual and Motor Skills

Sensory Profile

The epidemiology of Asperger syndrome: A total population study

Journal of Child Psychology and Psychiatry

Psychosocial functioning in a group of Swedish adults with Asperger syndrome or high-functioning autism

Autism

Clumsiness in autism & AS: A further report

Journal of Intellectual Disability Research