Young Children with ASD & Sensorimotor Development

By Rosalba Maistoru M.A., BCBA

It is believed that in the normal development sequence infants seek those sensations that they need and they seek novelty. From very early childhood, children are taught that they see with their eyes, hear with their ears, touch with their fingers, taste with their tongues and smell with their noses. For most young children, as they grow, they become increasingly proficient at taking in what they see, hear and feel, organizing this sensory information in a purposeful way to regulate their own behavior. They are able to learn about themselves and their world by going through their own discovery process and successfully interacting with and exploring their environment, so naturally and with ease.

Young children with autism spectrum disorder (ASD) do not follow the typical patterns of child development. In some, hints of future problems may be apparent from birth. In most cases, the problems become more noticeable as the child slips farther behind other children the same age. Other children start off well enough, but between 18 and 36 months old, they suddenly reject people, lose language and social skills they had already acquired. Still others express problems related to motor planning and motor performance.

Children with ASD often have significant problems related to sensory processing and sensorimotor deficits, even when their primary diagnosis is not sensory integration dysfunction (SID). Children with SID have difficulty registering or organizing and using the sensory information from their body and from the environment. When this process is disordered, problems in learning, development or behavior may become evident. Frequently, they show motor impairments, including poor muscle contraction around joints, low muscle tone, and decreased balance and equilibrium skills. Children with sensorimotor dysfunction typically have problems in accurately producing a movement or controlling the execution of a movement. Sensory processing, motor planning and motor performance delays are seen in young children with SID and ASD.

There are seven senses that form the foundation of Sensory Integration (SI). They are visual, auditory, touch, smell, taste, proprioception (body awareness and movement) and vestibular (pull of gravity). Moving stimulates the proprioceptive and vestibular senses. Proprioception is the sensation from our muscles, joints and ligaments and provides information about where our body parts are and what they are doing. The vestibular sense provides information through the inner ear about gravity and space, balance and movement, and about our head and body position in relation to the surface of the earth. Each sense acts individually and in union with the others to send us information about our environments and our body in each environment. These senses give us information about both our external environment and our internal environment.

According to Ayres (1979), an occupational therapist and neuropyschologist who formulated the theory of SI, describes it as the organization of sensation for use. SI refers to the processing of information from all sensory modalities as essential to learning and performance. It refers to the ability of the brain to actively use and interpret sensory stimuli for adaptive responses, such as responding appropriately to a particular situation. SI can be thought of as occurring in five sequential steps, sensory registration, orientation and attention, interpretation, organization of a response, and execution of that response.

Children with Sensory Integration Dysfunction (SID) exhibit unusual responses to touch and movement experiences. If they are oversensitive to touch sensations (tactile defensiveness), they will avoid touching and being touched and will shy away from messy play, physical contact with others, pets, certain textures of fabric, many foods, bumpy sock seams, etc. On the other hand, if they are under-responsive to touch sensations, they’ll crave touching and being touched. These children will be fingerpainting their arms, stuffing their mouths with too much food, shouting indoors, turning up the volume and bumping and crashing into people and furniture.

If children are oversensitive or defensive to movement experiences, their feet will never leave the ground. They will shun playground equipment, object to riding in the car or they may refuse to be picked up. In contrast, if they are under-responsive, they may crave intense movement and seem always to be in upside-down positions, they may swing on the tire swing for long periods and/or they are constantly on-the-go, they are either jumping, bouncing, rocking and/or swaying. Other movement problems may include continual misjudgment of distance and time, such as bumping into objects/people, tripping over, etc., an inability to coordinate movements needed to take part in age-appropriate activities and difficulties with fine motor skills like writing and dressing.

It is not always easy to assess the extent of a child’s learning difficulties in the preschool years. Developmentally based assessments of cognitive, communicative, social-emotional, adaptive, gross and fine motor skills provide important information for the development of an individualized educational intervention plan for preschool children with ASD and related conditions. Careful documentation of a child’s unique strengths and weaknesses can have a major impact on the design of effective intervention programs and is particularly critical, because each child presents his or her own unique developmental profile.

The prominent clinical features identifying children with ASD require that therapists in the early childhood settings consider behavioral regulation, control of environmental demands and a high level of structure during the intervention session to successfully treat the child with ASD. The stated goals should reflect the social, communication and behavioral constraints typically seen in children with ASD, including poor attention span, poor communication of needs, restlessness, clumsiness, motor control impairments, impaired peer interactions, and limited tolerance to social, tactile and environmental changes.

Two main types of interventions have been used for children with primary sensorimotor deficits, such as those with SID and ASD. The first is a process-oriented and/or sensorimotor approach, primarily used by occupational therapists, incorporating Piaget’s view that all children need opportunities to explore and discover on their own (child-directed) in order to make the appropriate linkages between what they already know and new learning. It focuses on the underlying processes of movement control like sensory reception, perception and integration. The second is a task-oriented and/or learning based approach, primarily used by psychologists, behavior specialists and educators, incorporating applied behavior analysis (ABA) and other behavior modification techniques. It focuses on developing the specific motor skills that children actually need to perform at home and at school, and training in the use of equipment and adaptations to the environment.

Treatments using a process-oriented (or SI/sensorimotor) approach are based on the foundation that sensations from the environment are registered and interpreted in the brain or central nervous system (CNS). These sensations then affect movements or motor responses. In turn, motor responses provide additional sensory input or feedback to the CNS. Within this sensory-motor loop, the therapist uses SI treatment to provide the appropriate sensory input to produce a functional motor response. The goal of intervention is to provide the CNS with the appropriate sensory input to encourage the progressive development of functional skills for daily life tasks.

Vestibular orientation is often at the crux of SI therapy. During treatment, an individual adjusts and reacts during movements like swinging, jumping, spinning, rocking and linear acceleration. An occupational therapist using principles of SI with specific education (preferably with advanced training, including a mentored experience) often uses this therapeutic method. Although it is mostly effective administered under the supervision of an occupational therapist, other therapists, such as physical therapists, speech pathologists or special educator, can also incorporate interventions using a sensory integration frame of reference/approach if they have had specific training in this intervention. In addition, this therapeutic method can often be accomplished at home with proper guidance of occupational therapists.

Interventions based on the task-oriented (or ABA/learning-based) approach used with children with ASD lends available evidence indicating that this approach may be more useful in changing functional skills in children with significant motor disabilities. Researchers have showed that developing activities targeting specific behaviors was successful in supporting the attainment of those functional behaviors. The benefits of this approach may be due to the principles of motor learning on which it is grounded (Larin, 1994). Motor learning indicates that motor performance is enhanced when children are afforded opportunities to experience and actively practice specific activities or tasks. The theoretical basis of the learning approaches provides evidence that should encourage therapists to examine the effects of integrating these principles into the development of motor skills, performance, and function.

Research on the effectiveness of interventions with children with significant sensorimotor disabilities, such as those with ASD, is more successful when functional skills are targeted. According to Wolery (1996), functional skills include those behaviors that are useful, enable the child to be more independent, foster learning more complex skills, allow a child to live in a less restrictive environment and enable the child to be cares for more easily. In general, interventions based in natural environments that teach or attempt to change behaviors in the context in which they would typically occur have been found to be most effective. Thus, ways of helping children with ASD and related disorders cope with unusual sensory responses within their ordinary environments or modifications to these environments might be expected to have more effects than would specific, one-to-one therapies.

While contemporary practice promotes a more task-oriented approach based on the systems or motor-learning perspective, clinically, there appears to be a variety of applications for integrating sensorimotor and behavior change-focused therapy techniques. Combining SI and ABA in the treatment of children with ASD can be appropriate, because the common perspectives shared by SI and contemporary ABA involve the emphasis on functional outcomes. Currently, studies indicate that therapists in pediatric practice use a multitheoretical or pluralistic approach utilizing several frames of reference. Selecting the treatment approach to use with any one individual, then, should be based on how the therapist analyzes and organizes theoretical information to improve function on a daily basis.

The impact of sensorimotor impairments on children with ASD and their families is substantial. It is important to acknowledge that the critical outcome of sensory and motor processes is to support functional participation in all aspects of daily life and not merely the achievement of developmental milestones. The need for movement provides a rationale for creating quality environments capable of sustaining positive learning and physical and mental growth. Elements can be designed to support the pleasure of bodily movement through space, offering variations of heat, light, sound, color, texture smell, and temporal pattern.

From the perspective of physical activity participation, developing basic motor skills are an essential part of normal child development. Identifying children with movement problems early in life is important, as this can lead to some form of support being put in place to prevent many of the problems of later years. Given access, opportunity and adult support, children with SID and ASD can explore their physical surroundings and prevent movement problems of this nature, that will not only interfere with their motor development, but will also be likely to impact on their social relationships and their opportunities to lead an active life.

References:
1. Ayres, A.J. (1979). Sensory integration and the child. Los Angeles: Western Psychological Services.
2. Larin, H. (1994). Motor learning: Theories and strategies for the practitioner. In S. Campbell (Ed.), Physical therapy for children (pp. 157-182). Philadelphia: W. B. Saunders.
3. Wolery, M. (1996). Early childhood special and regular education. In R. A. McWilliam (Ed.), Rethinking pull out services in early intervention: A professional resource (pp. 182-215). Baltimore: Paul H. Brookes.

Please note: All information is for educational purposes only, references to treatment or therapy options, programs, services or links are not endorsements and the author and any parties associated with the materials printed assume no responsibility for the use made of any and all information published or provided. These are not approaches that are recommended by Spectrum magazine, the author, or any of the magazines’ affiliates. Some of these treatments are considered controversial and may not be generally accepted by the scientific and medical community. We hope you will find the materials mentioned helpful as a means to begin learning more about autism spectrum disorders (ASD).