Spatial and temporal analysis of postural control in children with high functioning Autism Spectrum Disorder

BackgroundChildren with autism spectrum disorders (ASD) have poor postural stability. The objective of our study was to explore further postural capabilities in ASD children by measuring spatial as well as temporal displacement of the center of pressure using wavelet analysis.MethodThirty children with ASD (12.1 ± 2.9 years) and 30 sex-, age- and IQ-matched typically developing children participated in the study. We recorded postural control using Multitest, also called Balance Quest, Equilibre from Framiral^® in three viewing conditions (eyes open, eyes closed and with perturbed vision) and in two postural conditions (stable and unstable).ResultsOur results show that children with ASD displayed a deficit in postural stability in comparison with typically developing children, especially when sensory inputs are not all available.ConclusionSuch poor postural control in children with ASD could be due to both an impairment in using sensorial inputs appropriately and a deficit in the ability to compensate for sensorial changes.     

Postural sway patterns in children with autism spectrum disorder compared with typically developing children

Postural control is a fundamental building block of each child's daily activities. The aim of this study was to compare patterns of postural sway in children with autism spectrum disorder (ASD) with typically developing children (TD). We recruited 21 schoolchildren diagnosed with ASD aged 9–14 and 30 TD pupils aged 8–15. Postural sway parameters in composite, anteroposterior and mediolateral axis were reported. Furthermore we examined the impact of age and characteristics of autism on postural sway. Children with ASD exhibited higher amount of sway in anteroposterior range (p < 0.001), mediolateral range (p = 0.002), root mean square (p = 0.001), mean velocity (p = 0.03), and sway area (p = 0.007) compared with their TD peers. Children with ASD showed higher instability in mediolateral than anteroposterior axis though TD children demonstrated higher sway scores in anteroposterior than mediolateral direction. The rate of autism symptom severity significantly affected the postural sway in children with ASD (p < 0.05). In conclusion, patterns of postural control seem to be different in children with ASD compared with TD counterparts. This could be partially due to clinical features were underlying in ASD.     

A pilot randomised controlled trial of a group based social skills intervention for adults with autism spectrum disorder

BackgroundSocial skills training is commonly used for children and adolescents with ASD. There are few studies considering its efficacy in adults and those that exist usually compare it to standard treatment, as opposed to controlling for non-specific improvements that may result from receiving an intervention. We conducted a pilot study to investigate whether social skills training is more effective than non-specific support for adults with ASD.Methods19 adults with ASD were randomised to either social skills training or non-specific social interaction groups for 16 weeks. The Reading the Mind in the Eyes and Reading the Mind in the Voice Tasks were used to assess social cognition while the Social Responsiveness Scale (SRS-2) and the Weiss Functional Impairment Rating Scale (WFIRS-S) were used to measure real-life change pre- and post-treatment.ResultsTaken together, both groups improved across the course of the study on the ‘Eyes’ task (p = 0.049), SRS-2 (p = 0.03) and WFIRS-S (p = 0.053). However, there were no significant differences between the groups. There was some trend-level evidence that the social skills group improved more on the tests of social cognition (p ≤ 0.1 for group x time interaction). This was not the case for the SRS-2 (p = 0.25) and for the WFIRS-S there was a trend for the social interaction group to show greater improvements (p = 0.07).ConclusionsThis study did not show clear evidence of benefit from social skills training compared to facilitated social interaction, although larger studies are required to draw firm conclusions about efficacy.     

Toward a motor signature in autism: Studies from human-machine interaction

BackgroundAutism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders which core symptoms are impairments in socio-communication and repetitive symptoms and stereotypies. Although not cardinal symptoms per se, motor impairments are fundamental aspects of ASD. These impairments are associated with postural and motor control disabilities that we investigated using computational modeling and developmental robotics through human-machine interaction paradigms.MethodFirst, in a set of studies involving a human–robot posture imitation, we explored the impact of 3 different groups of partners (including a group of children with ASD) on robot learning by imitation. Second, using an ecological task, i.e. a real-time motor imitation with a tightrope walker (TW) avatar, we investigated interpersonal synchronization, motor coordination and motor control during the task in children with ASD (n = 29), TD children (n = 39) and children with developmental coordination disorder (n = 17, DCD).ResultsFrom the human–robot experiments, we evidenced that motor signature at both groups’ and individuals’ levels had a key influence on imitation learning, posture recognition and identity recognition. From the more dynamic motor imitation paradigm with a TW avatar, we found that interpersonal synchronization, motor coordination and motor control were more impaired in children with ASD compared to both TD children and children with DCD. Taken together these results confirm the motor peculiarities of children with ASD despite imitation tasks were adequately performed.DiscussionStudies from human-machine interaction support the idea of a behavioral signature in children with ASD. However, several issues need to be addressed. Is this behavioral signature motoric in essence? Is it possible to ascertain that these peculiarities occur during all motor tasks (e.g. posture, voluntary movement)? Could this motor signature be considered as specific to autism, notably in comparison to DCD that also display poor motor coordination skills? We suggest that more work comparing the two conditions should be implemented, including analysis of kinematics and movement smoothness with sufficient measurement quality to allow spectral analysis.     

Visual tasks and postural sway in children with and without autism spectrum disorders

We investigated the influences of two different suprapostural visual tasks, visual searching and visual inspection, on the postural sway of children with and without autism spectrum disorder (ASD). Sixteen ASD children (age = 8.75 ± 1.34 years; height = 130.34 ± 11.03 cm) were recruited from a local support group. Individuals with an intellectual disability as a co-occurring condition and those with severe behavior problems that required formal intervention were excluded. Twenty-two sex- and age-matched typically developing (TD) children (age = 8.93 ± 1.39 years; height = 133.47 ± 8.21 cm) were recruited from a local public elementary school. Postural sway was recorded using a magnetic tracking system (Flock of Birds, Ascension Technologies, Inc., Burlington, VT). Results indicated that the ASD children exhibited greater sway than the TD children. Despite this difference, both TD and ASD children showed reduced sway during the search task, relative to sway during the inspection task. These findings replicate those of Stoffregen et al. (2000), Stoffregen, Giveans, et al. (2009), Stoffregen, Villard, et al. (2009) and Prado et al. (2007) and extend them to TD children as well as ASD children. Both TD and ASD children were able to functionally modulate postural sway to facilitate the performance of a task that required higher perceptual effort.     

Effect of Wii-intervention on balance of children with poor motor performance

The purpose of this study was to investigate the effects of training with the Wii-balance board on balance and balance-related skills of children with poor motor performance. Twenty-nine children (23 boys, 6 girls; aged 7–12 years) participated in this study and were randomly assigned to an experimental and control group. All children scored below the 16th percentile on a standardized test of motor ability and balance skills (Movement Assessment Battery for children (M-ABC-2)). Before and after a six-week Wii-intervention (M = 8 h, 22 min, SD = 53 min), the balance skills of the experimental group and control group were measured with the M-ABC-2 and the Bruininks–Oseretsky test of motor proficiency (BOT-2). Both groups improved on all tests. The M-ABC-2 and the BOT-2 total balance-scores of the experimental group improved significantly from pre to post intervention, whereas those of the control group showed no significant progress. This resulted in significant interaction-effects, favoring the experimental children. No transfer-effects of the intervention on balance-related skills were demonstrated. Our findings showed that the Wii-balance board is an effective intervention for children with poor balance control. Further development and investigation of the intervention could be directed toward the implementation of the newly acquired balance-skills in daily life.     

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

BackgroundAttention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD.MethodADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2–5 from a large case-control study with ASD (n = 548), TD (n = 423), and DD (n = 180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales.ResultsMean hyperactivity subscale scores were lowest in children with TD (mean = 3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p < 0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = −5.63, p = 0.0005; Mullen visual reception scale = −2.94, p = 0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically.ConclusionThese results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.     

The effect of a combined strength and proprioceptive training on muscle strength and postural balance in boys with intellectual disability: An exploratory study

The aim of our study was to investigate the effect of a combined strength and proprioception training (CSPT) program on muscle strength and postural balance in children with intellectual disability (ID). The maximum voluntary contraction (MVC) and postural parameters (CoP_Vm, CoP_LX, CoP_LY) of 20 children with ID were recorded before and after 8 weeks of a CSPT program. The participants were divided into two groups: an experimental group who attended a CSPT program and a control group who continued with daily activities. In the trained group, the MVC increased significantly (p < 0.001) after the training period and the postural parameters decreased significantly in Double-Leg Stance (DLS) and One-Leg Stance (OLS) during the firm surface condition as well as in the DLS during the foam surface condition; in both eyes open (EO) and eyes closed (EC) conditions. A CSPT program improves postural balance in children with ID could be due to the enhancement in muscle strength and proprioceptive input integration.     

Efectos de la terapia con videojuegos comerciales sobre el equilibrio postural en pacientes con esclerosis múltiple: revisión sistemática y metaanálisis de ensayos clínicos controlados aleatorizados

IntroductionCommercial video games are considered an effective tool to improve postural balance in different populations. However, the effectiveness of these video games for patients with multiple sclerosis (MS) is unclear.ObjectivesTo analyse existing evidence on the effects of commercial video games on postural balance in patients with MS.Material and methodWe conducted a systematic literature search on 11 databases (Academic-Search Complete, AMED, CENTRAL, CINAHL, WoS, IBECS, LILACS, Pubmed/Medline, Scielo, SPORTDiscus, and Science Direct) using the following terms: “multiple sclerosis”, videogames, “video games”, exergam*, “postural balance”, posturography, “postural control”, balance. Risk of bias was analysed by 2 independent reviewers. We conducted 3 fixed effect meta-analyses and calculated the difference of means (DM) and the 95% confidence interval (95% CI) for the Four Step Square Test, Timed 25-Foot Walk, and Berg Balance Scale.ResultsFive randomized controlled trials were included in the qualitative systematic review and 4 in the meta-analysis. We found no significant differences between the video game therapy group and the control group in Four Step Square Test (DM: –.74; 95% CI, –2.79-1.32; P = .48; I² = 0%) and Timed 25-Foot Walk scores (DM: .15; 95% CI, –1.06-.76; P = .75; I² = 0%). We did observe intergroup differences in BBS scores in favour of video game therapy (DM: 5.30; 95% CI, 3.39-7.21; P < .001; I² = 0%), but these were not greater than the minimum detectable change reported in the literature.ConclusionsThe effectiveness of commercial video game therapy for improving postural balance in patients with MS is limited.     

Psychometric properties of the French Version of the Social Responsiveness Scale in autism spectrum disorder with or without attention deficit hyperactivity disorder

ObjectivesThe Social Responsiveness Scale (SRS) is an instrument that is commonly used to screen for Autism Spectrum Disorder (ASD). Attention Deficit Hyperactive Disorder (ADHD) frequently occurs with ASD and both disorders share some phenotypic similarities. In the present study, we aimed to determine the psychometric properties of the French version of the Social Responsiveness Scale (SRS) and its 5 subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerisms) to discriminate between children with ADHD and those with ASD (differential diagnosis) and children with ADHD from those with a dual diagnosis of ADHD and ASD (comorbid diagnosis).MethodSRS total scores and the 5 subscores of the SRS were compared between 4 groups of children: ADHD (n = 32), ASD + ADHD (n = 30), ASD (n = 31) and typical neurodevelopment (TD; n = 30) children. The discriminant validity was estimated using the Area Under the ROC Curves (AUC).ResultsSRS Social cognition (AUC = 0.73) and Autistic mannerisms (AUC = 0.70) subscores were the most discriminating for differential diagnosis of ASD and ADHD. SRS total scores (AUC = 0.70), and Social communication (AUC = 0.66) and Autistic mannerisms (AUC = 0.75) subscores were the most discriminating for comorbid diagnosis of ASD among ADHD children.ConclusionThe SRS autistic mannerisms subscore was found to be clinically relevant for both differential diagnosis of ASD and ADHD and comorbid diagnoses of ASD among ADHD children but with a modest discriminant power.     

Modulation of attention by socio-emotional scenes in children with autism spectrum disorder

BackgroundAbnormal attentional processes to socially relevant information may underlie social impairment in Autism Spectrum Disorder (ASD). To examine how these processes are modulated by the emotional salience of the stimuli, we studied the attentional biases to social scenes (happy, sad, and threatening) in ASD children.MethodAn emotional dot-probe task was applied to children (from 6 to 12 years old) with Autism Spectrum Disorder without additional language and/or intellectual impairments (ASD; n = 25) and age/sex-matched controls (n = 25).ResultsASD children showed an attentional bias toward threatening scenes while typically developing children tended to direct their attention toward sad scenes. There were no differences between groups for happy scenes.ConclusionsThreatening situations captured greater attention in ASD individuals than in the control participants. Thus, abnormal attention to emotionally relevant situations may negatively affect the ability of ASD children to adapt cognitively and emotionally, particularly in threatening situations.     

Differential effect of Taekwondo training on knee muscle strength and reactive and static balance control in children with developmental coordination disorder: A randomized controlled trial

This randomized controlled trial aimed to investigate the effect of short-term intensive TKD training on the isokinetic knee muscle strength and reactive and static balance control of children with developmental coordination disorder (DCD). Among the 44 children with DCD (mean age: 7.6 ± 1.3 years) recruited, 21 were randomly assigned to undergo daily TKD training for 1 h over three consecutive months, with the remaining 23 children being assigned to the DCD control group. Eighteen typically developing children (mean age: 7.2 ± 1.0 years) received no training as normal controls. Knee extensor and flexor muscle strength and reactive and static balance control were assessed using an isokinetic machine (with low, moderate and high movement velocities), a motor control test (MCT) and a unilateral stance test (UST), respectively. A repeated measures MANCOVA revealed a significant group through time interaction effect in isokinetic outcomes at 180°/s and in the UST outcome. Post hoc analysis demonstrated that DCD-TKD children's isokinetic knee muscle strength, specifically at 180°/s, was as high as that of the normal control children (p > 0.0083) after TKD training. Moreover, UST body sway velocity was slower in the DCD-TKD group than in the DCD control group (p < 0.001), and was comparable to that of the normal control group (p > 0.05) after TKD training. However, no such improvement in balance was observed in the MCT (p > 0.025). The results show that children with DCD who undergo a 3-month program of intensive TKD training experience improvements in isokinetic knee muscle strength at 180°/s and static single-leg standing balance control, but do not benefit from improved reactive balance control.     

Implicit and explicit motor learning: Application to children with Autism Spectrum Disorder (ASD)

Aims and objectivesThis study aims to determine whether children with Autism Spectrum Disorder (ASD) are capable of learning a motor skill both implicitly and explicitly.MethodsIn the present study, 30 boys with ASD, aged 7–11 with IQ average of 81.2, were compared with 32 typical IQ- and age-matched boys on their performance on a serial reaction time task (SRTT). Children were grouped by ASD and typical children and by implicit and explicit learning groups for the SRTT.ResultsImplicit motor learning occurred in both children with ASD (p = .02) and typical children (p = .01). There were no significant differences between groups (p = .39). However, explicit motor learning was only observed in typical children (p = .01) not children with ASD (p = .40). There was a significant difference between groups for explicit learning (p = .01).DiscussionThe results of our study showed that implicit motor learning is not affected in children with ASD. Implications for implicit and explicit learning are applied to the CO-OP approach of motor learning with children with ASD.     

Étude des altérations des habilités sociales chez des enfants ayant un Trouble Déficit de l’Attention/Hyperactivité : comparatif avec des sujets contrôles et des sujets présentant un Trouble du Spectre de l’Autisme

ObjectivesDifferent studies centered on social relationship issues among ADHD children struggled to provide a unicist explanation between primary social cognition process alteration on the one hand and a mere symptomatic outcome of the disorder triad on the other. Some authors support the idea of a potential “social phenotype” shared at a different intensity by Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The point of the study is to characterize this possible social disability in a French ADHD population and compare it to control subjects and subjects with Autism Spectrum Disorder (ASD).MethodsThree groups, composed of 319 subjects aged 6 to 12 years, were recruited in Bordeaux: 88 untreated ADHD subjects, 24 ASD subjects and 207 control subjects. The main measure was the social skill disruption through the rating of the Social Responsiveness Scale (SRS). The ADHD-RS-IV, WFIRS-P and CBCL scales were also used.ResultsAsignificant alteration in social abilities in ADHD children in comparison with controls was noted, with an average raw total SRS score intermediary between the control group and the ASD group (respectively 65.31 ± 20.99, 37.15 ± 16.37 and 95 75 ± 30.83, P < 0.05). When the 5 sub-scores of the SRS were taken into account, if the ASD subjects showed the highest average scores, the alteration pattern appeared qualitatively similar between the ADHD and TSA groups, with also an intermediate dispersion for the ADHD group between the control group and the group with ASD. Finally, more severe impairment of social skills in children with ADHD was associated with increased severity of the disorder (on ADHD-RS-IV scale cotation), higher daily functional impact (WFIRS-P scale), and more frequent behavioral issues (according to CBCL).ConclusionsOur results suggest the presence of social disturbances in ADHD and characterize a symptomatic profile qualitatively similar to that of ASD, but of less intensity. Overall results promote a need for a systematic dimensional assessment of social disability in ADHD.     

The efficacy of an aquatic program on physical fitness and aquatic skills in children with and without autism spectrum disorders

This study evaluated the efficacy of a 14-week aquatic program on physical fitness and aquatic skills for children with autism spectrum disorders (ASD) and their siblings without a disability. Children with ASD (n = 15) and their siblings (n = 15), between 7 and 12 years (8.55 ± 2.19 years) participated. In the first 14-week phase, 14 children (group A: ASD, n = 7; siblings, n = 7) received the aquatic program while 16 children (group B: ASD, n = 8; siblings, n = 8) did not. The arrangement was reversed in the second phase of another 14 weeks. Both groups continued their regular treatments/activities throughout the study. Improvements were seen in aquatic skills and physical fitness components except subtest body composition for group A and group B subsequent to aquatic program. The results provide evidence that intervention can be developed to promote motor skills and physical fitness components for children with ASD and their siblings.     

Improvement in social dysfunction of children with autism spectrum disorder following long term Kata techniques training

The purpose of the present study was to investigate the effects of long term Kata techniques training on social interaction of children with autism spectrum disorders (ASD). We assigned 30 school aged children with ASD to an exercise (n = 15) or a no-exercise group (n = 15). We required participants of the exercise group to exercise Kata techniques for 14 weeks, while participants of the control group received no exercise. We evaluated the social interaction of the participants at baseline, post-intervention (week 14), and at one month follow up. Results revealed that Kata techniques training significantly improved social dysfunction in the exercise group. Interestingly, at one month follow up improvement in social deficiency in the exercise group remained unchanged compared to post-intervention time. The social deficiency of participants of the control group was not changed across the experimental period. We concluded that teaching martial arts techniques to children with ASD leads to significant improvement in their social interaction.     

Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD)

BackgroundGroup social skills interventions (SSI) are partially effective for addressing the communication and social interaction impairments experienced by individuals with autism spectrum disorders (ASD). Social anxiety has been found to be a moderating mechanism for SSI in young people with ASD. Comparatively few studies have investigated the effectiveness of SSI in the adult ASD population, and none so far have investigated group approaches incorporating SSI and anxiety management techniques.MethodThe present study describes the design and evaluation of a non-randomised single-arm, 11 week group interaction anxiety and social skills intervention, piloted on three occasions during routine clinical practice at an adult ASD service. The intervention was informed by a cognitive behaviour therapy (CBT) framework. Eighteen cognitively-able adult males with ASD attended. Outcome measures were completed pre- and post-intervention.ResultsSelf-reported social anxiety improved (p = 0.01, d = 0.65). Low mood, general anxiety and functioning did not change significantly (p > 0.05, d < 0.20). Qualitative feedback indicated that participants found the intervention to be acceptable and useful for improving social knowledge and coping strategies, and reducing avoidance behaviours. Attrition was low (n = 2).ConclusionsThese results suggest that integrating SSI and anxiety management techniques in a group format is acceptable to adults with ASD, and can reduce symptoms of social anxiety. Whether SSI enhance social skills in adults requires further investigation. In clinical practice, consideration should be given to augmenting SSI with CBT techniques designed to target concurrent symptoms of social anxiety.     

Lower maternal serum 25(OH) D in first trimester associated with higher autism risk in Chinese offspring

ObjectiveThe aim of this study was to examine the association between maternal serum vitamin D status in first trimester and risk of ASD at age 3–7 years in the offspring.MethodsUsing a case-control design, 68 children diagnosed with ASD and 68 sex and age matched typically-developing children were included. Archived maternal blood samples from the first trimester of pregnancy (11–13 weeks gestational age) were identified for those participants. Maternal serum levels of 25 hydroxyvitamin D3 [25(OH) D], unmetabolized folic acid (FA), vitamin B12, homocysteine (HCY) and High Sensitivity C Reactive protein (CRP) were measured from those samples. We examined the associations between those factors in pregnancy and diagnosis of ASD with logistic regression using SPSS.ResultsMothers in autistic group had significantly lower maternal serum levels of 25(OH) D than in typically-developing group [19.2(IQR: 15.8–22.9)ng/ml vs. 24.3(19.3–27.3)ng/ml, P < 0.001], with 55.9% and 29.4% being vitamin D deficient, respectively (P < 0.001). Levels of 25(OH) D increased with decreasing severity of ASD as defined by the CARS score (r = − 0.302, P < 0.001). Maternal first trimester serum levels of 25(OH) D in the lower 3 quartiles (quartile 1, 2, 3) (compared to the highest quartile) was associated with increased odds of ASD diagnosis in offspring [OR (95% CI) Q1: 1.36(0.84–2.58, P = 0.25); Q2: 2.68(1.44–4.29, P = 0.006); Q3:3.99(2.58–7.12, P < 0.001)].ConclusionsLower first trimester maternal serum levels of 25(OH) D were associated with increased risk of developing autism in offspring. If these findings are confirmed, this may present an opportunity for prenatal intervention to reduce the risk for ASD.     

Examining the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders: A meta-analysis in single-case research using HLM

Social interaction is a fundamental problem for children with autism spectrum disorders (ASD). Various types of social skills interventions have been developed and used by clinicians to promote the social interaction in children with ASD. This meta-analysis used hierarchical linear modeling (HLM) to examine the effectiveness of peer-mediated and video-modeling approaches, the two approaches that are most commonly used for social skills training of children with ASD. The two approaches, with the average effect size of 1.27 (peer-mediated approach: mean = 1.3, 95% CL = 1.10–1.50, N = 9; video-modeling approach: mean = 1.22, 95% CL = 0.65–1.78, N = 5) were found to significantly and equally improve the social performance of children with ASD. In addition, age functioned as a significant moderator in the effectiveness of the intervention. Implications of the results and limitations of this study are discussed.