Perceptual & Motor Skills: Physical Development & Measurement 2013, 116, 1, 197-209. © Perceptual & Motor Skills 2013

SENSORY PROCESSING AND MOTOR SKILL PERFORMANCE IN ELEMENTARY SCHOOL CHILDREN WITH AUTISM SPECTRUM DISORDER1 TING LIU Texas State University - San Marcos Summary.—Research to examine both sensory processing and motor skill performance in children with autism spectrum disorder (ASD) is limited. This study assessed whether children with ASD would show sensory and motor delays compared to typically developing children and examined the relationship between sensory processing and motor performance. 32 children diagnosed with ASD were assessed using the Short Sensory Profile (SSP) and the Movement ABC–2 (MABC– 2). The SSP measures children’s sensory processing in daily life and the MABC–2 measures children’s fine and gross motor skill performance. Overall, the samples’ scores on the SSP indicated atypical sensory processing and scores on the MABC–2 showed poorer fine and gross motor performance as compared to age-matched norms. Furthermore, the samples’ scores for sensory processing were positively correlated with their motor performance. The results suggest that fine and gross motor difficulties of children with ASD may be related to their delayed sensory processing to visual, auditory, tactile, and movement stimuli, and that this hypothesis needs to be tested in future research.

Autism spectrum disorder (ASD) is the fastest growing pediatric diagnosis and affects about 1 in 88 U.S. children (Centers for Disease Control and Prevention, 2012). It is a disorder that is characterized by deficits in three developmental areas: language and communication, restrictive patterns of behavior or interest, and social interactions (American Psychiatric Association [APA], 2000). While a deficit in sensory and motor development is not a required characteristic for a diagnosis of ASD, developmental delays in motor skills and difficulties with sensory processing are concerns during the early stage of the diagnosis (Adrien, Lenoir, Martineau, Perrot, Hameury, Larmande, et al., 1993; O’Neill & Jones, 1997; Baranek, 1999; Baranek, David, Poe, Stone, & Watson, 2006). However, limited research is available on both sensory processing and motor skill performance for children with ASD compared to studies in language and social development. Researchers reported that children with ASD have difficulty in processing visual, auditory, and/or movement sensory input (Rogers & Ozonoff, 2005; Baranek, et al., 2006; Kern, Trivedi, Garver, Grannemann, Andrews, Savla, et al., 2006; Leekam, Nieto, Libby, Wing, & Gould, 2007). Address correspondence to Ting Liu, Ph.D., Department of Health and Human Performance, Texas State University–San Marcos, San Marcos, Texas 78666 or e-mail ([email protected]).

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DOI 10.2466/10.25.PMS.116.1.197-209

ISSN 0031-5125

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Studies also show that children with ASD exhibit atypical sensory processing, such as perceptual distortions, hypo and hyper responses, and preoccupations with sensory features of objects (Volkmar, Cohen, & Paul, 1986; LeCouteur, Rutter, Lord, Rios, Robertson, Holdgrafer, et al., 1989; Kientz & Dunn, 1997). Reports in the literature suggest that difficulties with sensory processing are a common concern for children with ASD. Greenspan and Weider (1997), for example, evaluated sensory processing difficulties of 200 children (ages 22 mo. to 4 yr.). They concluded that 100% of their study participants were challenged by poor auditory processing of incoming information. That is, they knew what they wanted to do, but could not answer an abstract question such as, “What do you want to do next?” In addition to auditory processing difficulties, children with ASD also have difficulty processing visual sensory input. Bertone, Motron, Jelenic, and Faubert, (2005) concluded that children with ASD experience reduced visual perceptual processing, as the complexity of visual stimuli increases in a visual-spatial static task (i.e., discriminating grating orientation). In addition, Kientz and Dunn (1997) reported that children with ASD tended to have hyper- and hypo-sensory responses (e.g., auditory, visual, touch, taste), and those atypical sensory processings can affect their daily living skills. The fact that children with ASD demonstrate impaired sensory processing suggests that their ability to perform motor skills may be affected as well (Dowell & Wallance, 2009; Bhat, Landa, & Galloway, 2011). Motor skill development research is relatively scarce when compared to research on language or social skills in children with ASD (Klin, Volkmar, & Sparrow, 1992; Stone, Lee, Ashford, Brissie, Hepburn, Coonrod, et al., 1999). Over the last two decades, studies examined whether children with ASD differ significantly from their age-matched peers in standardized measures of motor development (Manjiviona & Prior, 1995; Berkeley, Zittel, Pitney, & Nichols, 2001; Green, Baird, Barnett, Henderson, Huber, & Henderson, 2002; Rogers, Hepburn, Stackhouse, & Wehner, 2003; Provost, Lopez, & Heimerl, 2006; Provost, Heimerl, & Lopez, 2007). Researchers reported that fine motor skills were delayed in children with ASD (Green, et al., 2002; Provost, et al., 2007; Lane, Harpster, & Heathcock, 2012) and it is common to find they have difficulties with daily living tasks such as buttoning, writing, and feeding themselves. Children with ASD were also delayed in gross motor skills such as running, galloping, and throwing (Green, et al., 2002; Vernazza-Martin, Martin, Vernazza, Lepellec-Muller, Rufo, Massion, et al., 2005; Provost, et al., 2007; Lane, et al., 2012).

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Current research suggests that some children with ASD have motor delays and impairments in their motor skill performance (Vilensky, Damasio, & Maurer, 1981; Adrien, Perrot, Sauvage, Leddet, Larmande, Hameury et al., 1992; Adrien, et al., 1993; Berkeley, et al., 2001; Vernazza-Martin, et al., 2005; Downey & Rapport, 2012). Specific motor delays reported include manual dexterity, balance, primitive reflexes, and the presence of hypotonia (Adrien, et al., 1992; Adrien, et al., 1993; Stone, et al., 1999). Miyahara, Tsujii, Hori, Nakanishi, Kageyama, and Sugiyama (1997) found significant motor delays in 22 out of 26 children with Asperger Syndrome using the Movement Assessment Battery for Children (Henderson & Sugden, 1992). More recently, Provost, et al. (2007) reported that 84% of the participants’ scores in the ASD group were classified as significantly delayed on the Bayley Scale for Infant Development–II and 68% of participants scored at least two standard deviations below the norm mean on the Peabody Developmental Motor Scales–2. Several studies suggested that there were motor impairments in gait patterns in children with ASD. This includes shorter step length, postural asymmetry, and difficulties in executing the heel-to-toe pattern when compared to the typical developing children (Vilensky, et al., 1981; VernazzaMartin, et al., 2005; Esposito & Venuti, 2008; Esposito, Venuti, Apicella, & Muratori, 2011; Esposito, Yoshida, Venuti, & Kuroda, 2012). Investigation of early movement patterns of infants using videotape analysis has also been examined (Adrien, et al., 1992; Adrien, et al, 1993; Baranek, 1999; Teitelbaum, Benton, Shah, Prince, Kelly, & Teitelbaum, 2004; Esposito, Venuti, Maestro, & Muratori, 2009). Findings from these studies indicated that infants later diagnosed with ASD showed hypotonia, unusual postures, as well as persistence of primitive reflexes. The functional motor skill performance depends on an intact sensory system. Many children with ASD have difficulties integrating sensory inputs that may impair their ability to interact with others and the environment in motor skill performance (O’Neal & Jones, 1997). It is important to investigate sensory processing in relation to motor skill performance for children with ASD in order to develop interventions that will optimize children’s participation in physical activity, and improve their social and communication skills in school and sport settings. Research on both sensory processing and motor skill performance in children with ASD are limited but those that do exist illustrate the challenges that children with ASD have, which include inadequate sensory integration (e.g., Kern, et al., 2006; Leekam, et al., 2007; Abu-Dahab, Skidmore, Holm, Rogers, & Minshew, 2012) and motor delays (e.g., Green, et al., 2002; Provost, et al., 2007). To date, however, few studies have examined fine and gross motor performance in connection with sensory

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processing for children with ASD. As motor skill performance requires processing of sensory stimuli, it is expected that sensory processing of children with ASD could interfere with their motor skill performance. Furthermore, given that many environments are complex and unpredictable in terms of their sensory characteristics, it is essential to investigate sensory processing and motor skill performance of children with ASD to facilitate their adaptability in different contexts.

Hypothesis 1. Children with ASD would have delays in sensory processing and motor skill performance. Hypothesis 2. A positive correlation will be found between sensory processing and motor performance in children with ASD.



Method

Participants Thirty-five children with ASD were identified as candidates for this study. Participants were recruited through advertisements and personal contacts from local schools and organizations. Children were included if they had (a) been diagnosed with ASD, (b) the ability to understand and communicate with the examiners, (c) the ability to perform the required fine and gross motor skills, and (d) the ability to follow the directions. Three children were recruited but excluded from the analysis because they failed to complete the motor assessment. Therefore, 32 children with ASD (ages 5 to 11 years, M = 7.8, SD = 2.1; 26 boys, 6 girls) participated in this study. All children were diagnosed by psychiatrists or licensed psychologists according to DSM-IV–TR (APA, 2000) and met the inclusion criteria. Twelve children had a diagnosis of Asperger Syndrome, 12 were diagnosed with autistic disorder, and eight had a diagnosis of pervasive developmental disorder not otherwise specified (PDD–NOS). Participating parents were informed of their rights and the nature of the task, and were asked to sign a consent form prior to their child’s participation. The study was approved by the local University Institutional Review Board.

Instruments Short Sensory Profile (SSP).—The SSP is a 38-question caregiver-completed profile that reports the frequency of the child’s response to various sensory experiences (Dunn, 1999). Parents were asked to answer questions which best described the frequency with which the child engaged in sensory-related behaviors. The SSP measures children’s sensory processing abilities in seven sections, Tactile Sensitivity, Taste/Smell Sensitivity, Movement Sensitivity, Underresponsive/Seeks Sensation, Auditory Filtering, Low Energy/Weak, and Visual/Auditory Sensitivity. Sample statements

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for Visual/Auditory Sensitivity are “Holds hands over ears to protect ears from sound”, “Is bothered by bright lights after others have adapted to the light,” etc. Response choices included 5: Never, 4: Seldom, 3: Occasionally, 2: Frequently, and 1: Always. The sum of all points and categories provide a total sensory score that can be compared to normed values established by Dunn (1999). Out of a possible 190 points, a score range of 155–190 is categorized as typical-child behavior. A range of 142–154 indicates a probable difference from typical sensory processing, and a range of 38–141 indicates definite differences in child sensory processing. McIntosh, Miller, Shyu, and Dunn (1999) reported that reliability of the SSP is .90 and discriminate validity is > 95%. Occupational therapists who work with children with ASD recommended using the SSP because it measures the sensory threshold and has been found to accurately reflect the person’s sensory processing (Tomchek & Dunn, 2007). Further, there is evidencebased literature to support the use of the SSP in children with ASD (Ermer & Dunn, 1998; Watling, Deitz, & White, 2001; Tomchek & Dunn, 2007). Movement Assessment Battery for Children–2 (MABC–2).—The MABC–2 (Henderson, Sugden, & Barnett, 2007) contains eight fine and gross motor tasks for each of the three age bands (3–6 years, 7–10 years, and 11–16 years) in three areas: Manual Dexterity, Ball Skills, and Static and Dynamic Balance. The MABC–2 is an evaluative tool that can be used to identify children who are significantly behind their peers in motor-skill development. The MABC–2 can also assist in planning an intervention program in either a school or clinical setting, or serve as a measurement instrument in research involving motor development. Each task’s raw score can be converted to a standard score to determine a child’s motor delays compared to the age-matched norms. The test standard scores are described as red zone, amber zone, and green zone. A standard score of ≤ 5 is classified in the red zone indicating a significant motor delay, a standard score of > 5 and ≤ 7 is classified in the amber zone indicating at risk of motor delay and a stander score of > 7 is classified in the green zone indicating no motor delay detected. The reliability of MABC–2 was .79 (Chow, Chan, Chan, & Lau, 2002) and the concurrent validity was .76 (Tan, Parker, & Larkin, 2001).

Procedure Parents were asked to fill out the 38-item SSP questionnaire at home. The MABC–2 was administered at a local elementary school gym by the investigator and research assistants. Parents were given the opportunity to sign the consent form prior to the study. Each child received verbal descriptions and demonstrations prior to the motor skill performance. Participants were given additional directions if they did not understand the first time, when observed from their practice trials

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or if requested by the participants. A research assistant was trained to administer and evaluate the children’s performance on both the SSP and MABC–2. The principal investigator and a research assistant evaluated the children’s sensory profiles and motor-skill performances. The assistant was considered trained once a 90% agreement with the scores (total scores for SSP and standard scores for MABC–2) of the principal investigator was achieved (Bauer, Wenner, Dropik, & Wewerka, 2000; Saigal, Rosenbaum, Stoskopf, Hoult, Furlong, & Hagan, 2005). An inter-rater reliability test was performed between scores of the principal investigator and the assistant. Percentage of inter-rater agreement between the principal investigator and the assistant was high (98%). Data Analysis Descriptive statistical analyses were used for the SSP data. SSP categorical scores were summed and then converted to total scores. Fine- and grossmotor-skill raw scores were converted to standard scores for each child, using the MABC–2 conversion tables. Z tests were used to assess the difference in performance between the study participants and the MABC–2 norms (Moore, 1995; Thomas & Nelson, 1996). A 2 (gender) x 3 (ASD type) repeated measures analysis of variance (ANOVA) was conducted on the MABC– 2 standard scores. Further, a Pearson correlation coefficient was calculated for the relationship between children’s sensory processing and motor performance. The total scores of the SSP and MABC–2 were used in the correlation calculation. Results were considered significant if an alpha level was .05. In addition to statistically significant findings, effect sizes (ES) were determined using Cohen’s d (Cohen, 1988).

Results Demographic information of the participants including ages, sex, SSP, and MABC–2 mean and standard deviation scores are presented in Table 1. The scores of all children fell in the definite difference range according to the sensory response classification defined in the SSP manual. This finding suggests the participants in the present study did not process sensory information like the normative sample and may be struggling to keep up with what is going on in the environment (Table 2). In addition, all participants were in the definite difference range on all seven sensory processing categories (tactile sensitivity, taste/smell sensitivity, movement sensitivity, underresponsive/seeks sensation, auditory filtering, low filtering, low energy/ weak, and visual/auditory sensitivity). The definite difference range indicates that the children scored two standard deviations below the mean of agematched norms, and performed like children in the lowest 2%, when compared to the scores in the normative sample of children without disabilities. MABC–2 standard scores for children with ASD are presented in Ta-

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ble 3. According to the MABC–2 traffic light scoring system, the majority of children (78%) were in the red zone indicating that they had significant movement delays, 6% of the children were in the amber zone suggesting that they were at risk of having movement delays, and 16% of the children were in the green zone and had no movement delays. TABLE 1 Demographic Information of the Participants on Ages, Sex, SSP, and MABC–2 Scores Autism Spectrum Disorder

Age (yr.)

n

Asperger syndrome

7.42

12

PDD-NOS

7.50

8

Autistic disorder

8.25

12

Sex

SSP Total Score

Boys Girls

M

SD

MABC–2 Standard Score M

SD

9

3

83.75

20.79

4.92

3.03

7

1

87.38

12.66

3.75

2.38

10

2

80.75

12.23

3.42

2.35

Note.—PDD-NOS stands for, “Pervasive developmental disorder - not otherwise specified.”

The effect sizes describing motor delays between the study participants and the norms were large on all tasks (> .80) (Table 3). The effect size results suggest the true effect in the population may be large. Z tests were performed to compare the standard scores of the MABC–2 for participants in the current study and the respective age-matched norms (Table 3). Z tests were statistically significant with the participants scoring significantly lower than the norms on both fine and gross motor skills. TABLE 2 Short Sensory Profile (SSP) Total Scores and Classification for Children with Autism Spectrum Disorder Section M SD Classification (N = 32) Tactile sensitivity 15.14 3.83 Definite Difference Taste/smell sensitivity 8.50 3.15 Definite Difference Movement sensitivity 5.00 2.08 Definite Difference Under-responsive; seeks sensation 6.50 1.56 Definite Difference Auditory filtering 13.79 2.75 Definite Difference Low energy 2.29 1.38 Definite Difference Visual/auditory sensitivity 13.21 3.89 Definite Difference Total score 120.07 21.95 Definite Difference Note.—“Definite difference” means that there was a difference of 2 standard deviations and that the score was in the bottom 2%.

The Pearson correlation showed that a significant positive relationship (r30 = .42, p < .05) exists between children’s sensory processing scores and their MABC–2 standard scores. This finding indicates that children

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with poor sensory processing tend to be more delayed on motor skill performance. Children with ASD’s poor sensory processing may be related to their delayed motor performance; this hypothesis needs to be tested in future research. TABLE 3 Movement ABC–2 Standard Scores of Children with Autism Spectrum Disorder Compared to Normative Sample M

SD

ES

Z score

p

All motor skills 4.06 2.64 –1.99 –2.25 .01 Manual dexterity 4.56 2.56 –1.82 –2.12 .02 Ball skills 4.92 2.73 –1.70 –1.86 .03 Static and dynamic balance 5.31 2.53 –1.57 –1.85 .03 Note.—ES were compared to MABC–2 normative data. All differences were significant.

The ANOVA analysis did not indicate a significant difference between the scores of the boys and girls (F1,30 = .07, p = .79). In addition, no significant performance difference across types of ASD was found (F2,29 = .60, p = .56). These results suggested that children with ASD were delayed on fine and gross motor skills regardless of sex or type of ASD. Discussion

Sensory Reponses It was found that children with ASD had atypical sensory processing compared to a normative sample from the SSP. When a child obtains a poor SSP score (i.e., in the definite difference range), it suggests the possibility that they may have inaccurate or insufficient sensory information. All of the children’s SSP total scores (100%) fell in the definite difference range. This finding is consistent with Leekam, et al. (2007) that children with ASD commonly have a high percentage of atypical sensory processing. Furthermore, the ASD sample showed considerable variability in sensory response (i.e., high individual differences). For example, even within the same disorder, some children scored high on auditory sensitivity category but low on movement sensitivity and others scored high on both auditory and movement sensitivity. This finding is concurrent with Rogers and Ozonoff (2005) in that atypical sensory processing should be secondary in the diagnosis because they are insufficient to characterize children with ASD. Therefore, with the low number of girls (n = 6) in the sample, and limited participants with each disorder type for this study, it is difficult to generalize about atypical sensory processing in children with ASD. However, the low

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scores on the specific sensory processing emphasize that these should not be neglected.

Motor Skills The standard scores of children with ASD indicated significant motor delays on both fine and gross motor skills compared to the norms, similar to the findings of Provost, et al., (2007). Participants’ lowest scores were in the areas of manual dexterity and ball skills, where the mean MABC–2 standard scores of the children with ASD were all in the red zone. It has been suggested that poor motor performance of children with ASD may be due to deficits in their sensory processing (Smith, 2004; Vanvuchelen, Roeyers, & De Weerdt, 2007). The present findings support the research suggesting that children with ASD are delayed in motor development (Manjiviona & Prior, 1995; Berkeley, et al., 2001; Green, et al., 2002; Rogers, et al., 2003; Provost, et al., 2007). When compared to language or social skills, motor delays may have been overlooked because children with ASD normally start to sit and walk at the same age as typically developing children (Provost, et al., 2007). In addition, children with ASD have functional mobility such as sitting, climbing up and down stairs, and walking. However, mobility is a functional measure of independence, whereas manual dexterity, aiming and catching, and balance in MABC–2 are qualitative and quantitative indicators of fine and gross motor skill performance. A child not only should be able perform each motor skill, but also needs to perform the skills in an accurate and timely manner. The lack of clarification between motor performance and mobility may explain why fewer research studies have investigated motor delays in children with ASD and why so few motor skill development intervention programs have been designed to target children with ASD. Sensory and Motor Processing Sensory processing in children with ASD often encompasses activities in daily living. Knowledge of sensory differences in children with ASD can assist in the understanding and reframing of behaviors to enhance performance of daily motor skills (Provost, et al., 2009). One of the key findings of this study was the positive correlation between sensory processing and motor performance. This finding has an important implication for practitioners working with children with ASD to develop effective interventions for improving daily living motor skills and integration of using sensory input in motor performance. For example, occupational therapists can improve a child’s fine and gross motor skill performance by using sensory processing activities. That is, they could require a child to write between two lines to improve his/her handwriting fine motor skill performance with visual guidance. They could also ask the child to walk

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on different surfaces and stomp feet to improve gross motor skill performance by modulating the child’s tactile sensitivity. A limitation of this study is that information was not collected on children with other intellectual disabilities as a matching group. Therefore, it is possible that some children with ASD’s sensory processing may or may not be influenced their motor skill performance as much as children with other levels of intellectual disabilities. Conclusion Children with ASD in this study presented atypical sensory processing and motor delays. The poor fine and gross motor skill performance may be related in part to the children’s atypical sensory processing. Sensory processing is crucial to children’s motor skill acquisition in early childhood (Piaget, 1952; Kellman, & Arterberry, 1998; Haywood & Getchell, 2009). Therefore, it is valuable to establish a strong sensory processing and motor performance foundation early on, to facilitate more complex motor-skill performance and learning later in life. To achieve this goal, children with ASD should be individually assessed so that educators can identify their special needs and develop interventions according to each child’s unique situation. Future researchers should collect data with more girls, a higher number of children in each disorder, and a group of typically developing children to better explain whether sensory processing and motor performance differences exist in gender, and the types of ASD for this population. References

Abu-Dahab, S. M., Skidmore, E. R., Holm, M. B., Rogers, J. C., & Minshew, N. J. (2012) Motor and tactile-perceptual skill differences between individuals with highfunctioning autism and typically developing individuals ages 5-21. Journal of Autism and Developmental Disorders. Advance online publication. DOI: 10.1007/ s10803-011-1439-y. Adrien, J. L., Lenoir, P., Martineau, J., Perrot, A., Hameury, L., Larmande, C., & Sauvage, D. (1993) Blind rating of early symptoms of autism based upon family home movies. Journal of American Academy of Child and Adolescent Psychiatry, 32, 617-626. Adrien, J. L., Perrot, A., Sauvage, D., Leddet, I., Larmande, C., Hameury, L., & Berthelemy, C. (1992)  Early symptoms in autism from family home movies. Evaluation and comparison between first and second year of life using I.B.S.E. scale. Acta Paedopsychiatrica, 55(2), 71-75. American Psychiatric Association. (2000)  Diagnostic and Statistical Manual of Mental Disorders. (4th ed., DSM-IV–TR) Washington DC: American Psychiatric Association. Bayley, N. (1993) Bayley scales of infant Development manual. (2nd ed.) San Antonio, TX: The Psychological Corporation.

Sensory and motor performance in ASD

207

Baranek, G. T. (1999)  Autism during infancy: a retrospective video analysis of sensory-motor and social behaviors at 9–12 months of age. Journal of Autism and Developmental Disorders, 29, 213-224. Baranek, G. T., David, F. J., Poe, M. D., Stone, W. L., & Watson, L. R. (2006)  Sensory experiences questionnaire: discriminating sensory features in young children with autism, developmental delays, and typical development. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47, 591-601. DOI: 10.1111/j.14697610.2005.01546.x. Bauer, P. J., Wenner, J. A., Dropik, P. L., & Wewerka, S. S. (2000)  Parameters of remembering and forgetting in the transition from infancy to early childhood. Monographs of the Society for Research in Child Development, 65, no. 4 (Serial No. 263). Berkeley, S. L., Zittel, L. L., Pitney, L. V., & Nichols, S. E. (2001)  Locomotor and object control skills of children diagnosed with autism. Adapted Physical Activity Quarterly, 18, 405-416. Bertone, A., Motron, L., Jelenic, P., & Faubert, J. (2005)  Enhanced and diminished visual spatial information processing in autism depends on stimulus complexity. Brain, 128, 2430-2441. Bhat, A. N., Landa, R. J., & Galloway, J. C. (2011)  Current perspectives on motor functioning in infants, children and adults with autism spectrum disorders. Physical Therapy, 91, 1-14. Centers for Disease Control and Prevention. (2012)  New data on autism spectrum disorders. Retrieved from http://www.cdc.gov/Features/CountingAutism. Chow, S., Chan, L. L., Chan, C. P. S., & Lau, C. H. Y. (2002)  Reliability of the experimental version of the Movement ABC. British Journal of Therapy and Rehabilitation, 9, 404-407. Cohen, J. (1988)  Statistical power analysis for the behavioral sciences. (2nd ed.) New York: Academic Press. Dowell, L., & Wallace, M. T. (2009)  Unisensory and multisensory disruptions in autism spectrum disorders. Neuroscience, 1, 39-45. Downey, R., & Rapport, M. J. (2012)  Motor activity in children with autism: a review of current literature. Pediatric Physical Therapy, 24(1), 2-20. Dunn, W. (1999) Sensory profile. San Antonio, TX: The Psychological Corporation. Ermer, J., & Dunn, W. (1998)  The sensory profile: a discriminate analysis of children with and without disabilities. American Journal of Occupational Therapy, 52(4), 283291. Esposito, G., & Venuti, P. (2008)  Analysis of toddlers’ gait after six months of independent walking to identify autism: a preliminary study. Perceptual & Motor Skills, 106(1), 259-269. Esposito, G., Venuti, P., Apicella, F., & Muratori, F. (2011)  Analysis of unsupported gait in toddlers with autism. Brain & Development, 33(5), 367-373. Esposito, G., Venuti, P., Maestro, S., & Muratori, F. (2009)  An exploration of symmetry in early autism spectrum disorders: analysis of lying. Brain & Development, 31(2), 131-138. Esposito, G., Yoshida, S., Venuti, P., & Kuroda, K. O. (2012)  Three lessons from Philip Teitelbaum and their application to studies of motor development in humans and mice. Behavioural Brain Research, 231(2), 366-370.

208

T. Liu

Folio, M. R., & Fewell, R. R. (2000) Peabody Developmental Motor Scales examiner’s manual. (2nd ed.) Austin, TX: Pro-Ed. Green, D., Baird, G., Barnett, A. L., Henderson, L., Huber, J., & Henderson, S. E. (2002) The severity and nature of motor impairment in Asperger’s syndrome: a comparison with specific developmental disorder of motor function. Journal of Child Psychology and Psychiatry, 45(5), 655-668. Greenspan, S. I., & Weider, S. (1997)  Developmental patterns and outcomes in infants and children with disorders in relating and communicating: a chart review of 200 cases of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders, 1, 87-141. Haywood, K., & Getchell, N. (2009)  Life span motor development. (5th ed.) Champaign, IL: Human Kinetics. Henderson, S. E., & Sugden, D. A. (1992)  Movement Assessment Battery for Children. London: Psychological Corporation. Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2007)  Movement Assessment Battery for Children. (2nd ed.) London: Harcourt Assessment. Kellman, P. J., & Arterberry, M. E. (1998)  The cradle of knowledge: development of perception in infancy. Cambridge, MA: MIT Press. Kern, J. K., Trivedi, M. H., Garver, C. R., Grannemann, B. D., Andrews, A. A., Savla, J. S., Johnson, D. G., Mehta, J. A., & Schroeder, J. L. (2006)  The pattern of sensory processing abnormalities in autism. Autism, 10, 480-494. DOI: 10.1177/1362361306066564. Kientz, M. A., & Dunn, W. (1997)  A comparison of the performance of children with and without autism on the sensory profile. The American Journal of Occupational Therapy, 51, 530-537. Klin, A., Volkmar, F. R., & Sparrow, S. S. (1992)  Autistic social dysfunction: some limitations of the theory of mind hypothesis. Journal of Child Psychology and Psychiatry and Allied Disciplines, 33, 861-876. Lane, A., Harpster, K., & Heathcock, J. (2012)  Motor characteristics of young children referred for possible autism spectrum disorder. Pediatric Physical Therapy, 24(1), 21-29. LeCouteur, A., Rutter, M. L., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., & McLennan, J. D. (1989)  Autism Diagnostic Interview: a standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19, 363-387. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2007)  Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37, 894-910. DOI: 10.1007/s10803-006-0218-7. Manjiviona, J., & Prior, M. (1995)  Comparison of Asperger syndrome and high-functioning autistic children on a test of motor impairment. Journal of Autism and Developmental Disorders, 25(1), 23-39. McIntosh, D. N., Miller, L. J., Shyu, V., & Dunn, W. (1999)  Overview of the Short Sensory Profile (SSP). In W. Dunn (Ed.), The sensory profile: examiner’s manual. San Antonio, TX: The Psychological Corporation. Pp. 59-73. Miyahara, M., Tsujii, M., Hori, M., Nakanishi, K., Kageyama, H., & Sugiyama, T. (1997) Brief report: motor incoordination in children with Asperger syndrome and learning disabilities. Journal of Autism and Developmental Disorders, 27(5), 595-603. Moore, D. S. (1995)  The basic practice of statistics. New York: Freeman. O’Neill, M., & Jones, R. S. (1997)  Sensory-perceptual abnormalities in autism: a case for more research? Journal of Autism and Developmental Disabilities, 27(3), 283-293. Piaget, J. (1952)  The origins of intelligence in children. New York: W. W. Norton & Company.

Sensory and motor performance in ASD

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Provost, B., Heimerl, S., & Lopez, B. R. (2007)  Levels of gross and fine motor development in young children with autism spectrum disorder. Physical and Occupational Therapy in Pediatrics, 27(3), 21-36. Provost, B., Lopez, B. R., & Heimerl, S. (2006)  A comparison of motor delays in young children: autism spectrum disorder, developmental delay, and developmental concerns. Journal of Autism and Developmental Disabilities, 37, 321-328. Rogers, S. J., Hepburn, S. L., Stackhouse, T., & Wehner, E. (2003)  Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44(5), 763-781. Rogers, S. J., & Ozonoff, S. (2005)  Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46, 1255-1268. DOI: 10.1111/j.14697610.2005.01431.x. Saigal, S., Rosenbaum, P., Stoskopf, B., Hoult, L., Furlong, W., & Hagan, R. (2005) Development, reliability and validity of a new measure of overall health for pre-school children. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 14, 243-257. Smith, I. M. (2004)  Motor problems in children with autistic spectrum disorders. In D. Dewey & D.E. Tupper (Eds.), Developmental motor disorders: a neuropsychological perspective. New York, NY: The Guilford Press. Pp. 152-168. Stone, W. L., Lee, E. B., Ashford, L., Brissie, J., Hepburn, S. L., Coonrod, E. E., & Weiss, B. H. (1999) Can autism be diagnosed accurately in children under 3 years? Journal of Child Psychology and Psychiatry, 40, 219-226. Tan, K. S., Parker, H. E., & Larkin, D. (2001)  Current validity of motor tests used to identify children with motor impairment. Adapted Physical Activity Quarterly, 18, 168-182. Teitelbaum, O., Benton, T., Shah, P. K., P rince, A., K elly, J. L., & Teitelbaum, P. (2004) Eshkol-Wachman movement notation in diagnosis: the early detection of Asperger’s syndrome. Proceedings of the National Academy of Sciences of the United States of America, 101, 11909-11914. Thomas, J. R., & Nelson, J. K. (1996)  Research methods in physical activity. (3rd ed.) Champaign, IL: Human Kinetics. Tomchek, S. D., & Dunn, W. (2007)  Sensory processing in children with and without autism: a comparative study using the short sensory profile. American Journal of Occupational Therapy, 61, 190-200. Vanvuchelen, M., Roeyers, H., & De Weerdt, W. (2007)  Nature of motor imitation problems in school-age boys with autism. Autism, 11, 225-240. DOI: 10.1177/1362361307076846. Vernazza-Martin, S., Martin, N., Vernazza, A., Lepellec-Muller, A., Rufo, M., Massion, J., & Assaiante, C. (2005)  Goal directed locomotion and balance control in autistic children. Journal of Autism and Developmental Disorders, 35(1), 91-102. Vilensky, J. A., Damasio, A. R., & Maurer, R. G. (1981)  Gait disturbances in patients with autistic behavior: a preliminary study. Archives of Neurology, 38, 646-649. Volkmar, F. R., Cohen, D. J., & Paul, R. (1986)  An evaluation of DSM–III criteria for infantile autism. Journal of the American Academy of Child Psychiatry, 25, 190-197. Watling, R. L., Deitz, J., & White, O. (2001)  Comparison of sensory profile scores of young children with and without autism spectrum disorders. American Journal of Occupational Therapy, 55, 416-423.

Accepted January 18, 2013.