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.     

Discriminant validity of spatial and temporal postural index in children with neurodevelopmental disorders

Autism, learning disabilities and attention deficit/hyperactive disorder are often comorbid disorders. In order to try and find some markers that might be transnosographic, we hypothesized that abnormal postural sway profiles may discriminate children with neurodevelopmental disorders (NDDs) from typically developing children. The aim of our study was thus to compare spatial and temporal measures of the Center of Pressure in three distinct groups of children with NDDs (high functioning autism spectrum disorders, learning disabilities (dyslexia) and attention deficit/hyperactive disorders) and in typically developing children. Postural performances were thus evaluated in 92 children (23 per group, sex-, age- and IQ-matched groups) by using the Multitest Equilibre platform (Framiral^®). Two viewing conditions (eyes open and eyes closed) were tested on a stable and unstable platform.Results reported similar poor postural instability for the three groups of children with NDDs with respect to the typically developing children, and this was observed for both spatial as well as temporal analysis of displacement of the center of pressure.Such postural instability observed in children with NDDs could be due to impairment in using sensorial inputs to eliminate body sway, probably due to poor cerebellar integration.     

Do children with autism and Asperger's disorder have difficulty controlling handwriting size? A kinematic evaluation

Children with autism spectrum disorders (ASD) often show difficulties in controlling letter size and consistent letter formation during handwriting; however, there has been little research into the underlying nature of handwriting impairments in this group. The aim of this study was to assess the ability of children with ASD to regulate the size and consistency of fundamental handwriting movements when using writing guides, and determine whether the kinematic profile during writing is different to typically developing children. Twenty-six boys with ASD (16 with high-functioning autism, 10 with Asperger's disorder) aged 8–13 years (IQ > 75), and 17 typically developing children wrote a series of four cursive letter l's using 10 mm and 40 mm writing guides, using a graphics tablet and stylus. Movement size and consistency was comparable between groups when the writing guides were set at 10 mm; however, handwriting movements of children with ASD were significantly faster and more fluent than typically developing children when writing guides were set at 40 mm. Neuromotor noise was comparable to that of typically developing children across both writing sizes. Clinically, our findings indicate that children with ASD have a well-automated motor plan for simple handwriting movements when writing guides are present and that problems of handwriting legibility in ASD are likely to arise from other factors, such as complex motor chaining (i.e. writing whole words and sentences), or attentional, working memory and linguistic demands when writing.     

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.     

The effects of balance training intervention on postural control of children with autism spectrum disorder: Role of sensory information

PurposeThe aim of this study was to investigate the effect of balance training intervention in children with autism spectrum disorder (ASD), and to explore the relative role of the sensory systems in such kids.MethodologyWe recruited 20 school children (IQ > 80) diagnosed with ASD, and categorized them in two groups; a 10-member training group (average age: 7.70 ± 1.05) and a 10-member control group (average age: 7.90 ± 1.10). Thus, following a six-week-long balance training intervention in four conditions of bipedal upright stance [compliant (Foam) vs. non-compliant (Hard) with eyes-open (EO) vs. eyes-closed (EC)], we examined measures such as mean velocity (V), anteroposterior (AP) and mediolateral (ML) axis displacement, and compared the results to those calculated prior to the initiation of the intervention using MANOVA test.ResultsThis study showed that the balance training program efficiently improved the postural control in ASD suffering children, and that removing the visual and plantar proprioceptive information led to increased sway in both groups. The training group performed significantly better than the control group in all conditions.ConclusionIt is thus concludable that children suffering from ASD can benefit from such balance training programs to improve their balance and postural control.     

The link between emotion regulation,social functioning,and depression in boys with ASD

PurposeSymptoms of depression are common in children and adolescents with an autism spectrum disorder (ASD), but information about underlying developmental factors is limited. Depression is often linked to aspects of emotional functioning such as coping strategies, but in children with ASD difficulties with social interactions are also a likely contributor to depressive symptoms.MethodologyWe examined several aspects of emotional coping (approach, avoidant, maladaptive) and social functioning (victimization, negative friendship interactions) and their relation to depression symptoms in children with ASD (N = 63) and typically developing (TD) peers (N = 57). Children completed a battery of self-report questionnaires.ResultsLess approach and avoidant, but more maladaptive coping strategies, and poor social functioning were uniquely associated with more symptoms of depression in children with ASD. Only less approach and more maladaptive coping were uniquely associated with depression severity in TD boys.ConclusionsUnlike TD boys, boys with ASD who report using avoidant strategies to deal with stressful situations report fewer symptoms of depression, suggesting that this may be an adaptive emotion regulation strategy. However, understanding the role of over-arousal in this process, inferences about long-term effects of this strategy, its causality and direction of effects will require additional research.     

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.     

High plasma neopterin levels in Chinese children with autism spectrum disorders

BackgroundNeopterin, a pteridine mainly synthesized by activated macrophages, is a marker of inflammation, immune system activation and an active participant in Autism spectrum disorders (ASD). The aim of this study was to assess the clinical significance of plasma neopterin levels in ASD.MethodsEighty patients diagnosed with ASD and 80 sex and age matched typically developing children were assessed for plasma levels of neopterin at admission. Plasma neopterin levels were measured using a human ELISA kit and severity of ASD were evaluated with the Childhood Autism Rating Scale (CARS) score.ResultsWe found that the mean plasma neopterin level was significantly (P < 0.0001) higher in children with ASD as compared to controls. Plasma neopterin increased with increasing severity of ASD as defined by the CARS score. Based on the ROC curve, the optimal cutoff value of plasma neopterin level as an indicator for auxiliary diagnosis of ASD was projected to be 8.5 nmol/L, which yielded a sensitivity of 84.2% and a specificity of 80.1%, with the area under the curve at 0.876 (95% CI, 0.825–0.928). Elevated neopterin (≥8.5 nmol/L) was an independent diagnosis indicator of ASD with an adjusted OR of 12.11 (95% CI: 5.48–28.11; P < 0.0001).ConclusionsThese results indicated that autistic children had higher plasma levels of neopterin, and elevated plasma neopterin levels may be associated with severity of ASD among Chinese children.     

Autistic children do not exhibit an own-race advantage as compared to typically developing children

The characteristics of aberrant face processing in individuals with autism spectrum disorder (ASD) have been extensively studied, but the aspect regarding sensitivity to race is relatively unexplored. The present study hypothesized that the magnitude of the other-race effect shall be reduced in individuals with ASD owing to their inattention to faces since infancy. Using a sequential face discrimination task, we tested the other-race effect of 18 ASD (mean age = 7.5 years) and 13 age-matched typically developing (TD) children (mean age = 7.6 years). The stimuli were cropped Asian and African faces, each with four levels of difficulty: easy (change identity), medium (replaced eyes), hard-eye (widen eye spacing), and hard-mouth (moved up mouth). The TD children showed a significant own-race advantage such that the best performance was found in the Asian easy condition. The ASD children did not exhibit such advantage at all. Moreover, ASD children showed the highest error rates in the hard-eye condition instead of the hard-mouth condition, indicating insensitivity to eyes region. In sum, our findings support the hypothesis that the other-race effect is reduced in ASD children, reflecting an incomplete development of an expert face system.     

Spatial and temporal postural analysis: a developmental study in healthy children

The aim of this study was to explore further the development of postural control in healthy children. The novelty of this study was to resort to both spatial and temporal analysis of the center of pressure (CoP).Forty-six healthy children from 4 to 16 years old (mean age: 9.1 ± 3 years) and a group of 13 healthy adults (mean age: 25 ± 3 years) participated to this study. Postural control was tested on both a stable and an unstable platform in three different visual conditions: eyes open fixating a target, under optocinetic stimulation, and eyes closed.Resul*ts showed a significant decrease of both surface area as well as mean velocity of the center of pressure (CoP) during childhood. With the children's increasing age, the spectral power indices decreased significantly and the canceling time increased significantly.Such improvement in postural control could be due to a better use of sensorial inputs and cerebellar integration during development, allowing subjects to achieve more efficient postural control.     

Rates of psychotropic medication use in children with ASD compared to presence and severity of problem behaviors

There is a scarcity of research on the relationship between presence of problem behaviors and psychotropic medication use in children with autism spectrum disorder (ASD). Participants in the current study were children and adolescents ages 3–17 years who were sorted into four groups: ASD on psychotropic medication (N = 100), ASD not on psychotropic medication (N = 147), typically developing on medication (N = 48), and typically developing not on medication (N = 168). A one-way multivariate analysis of covariance (MANCOVA) was conducted to determine the relationship between medication use and rates of internalizing and externalizing behaviors. Post hoc analyses revealed that children with ASD on psychotropic medication evinced significantly more externalizing behaviors than children with ASD not on medication. However, the two groups did not significantly differ on rates of internalizing behaviors. These results suggest that psychotropic medications may often be prescribed to manage externalizing behaviors. Implications of these findings are discussed in relation to the existing literature.     

Reactive/proactive aggression and affective/cognitive empathy in children with ASD

The main aim of this study was to examine the extent to which affective and cognitive empathy were associated with reactive and proactive aggression, and whether these associations differed between children with an Autism Spectrum Disorder (ASD) and typically developing (TD) children. The study included 133 children (67 ASD, 66 TD, Mage = 139 months), who filled out self-report questionnaires. The main findings showed that the association between reactive aggression and affective empathy was negative in TD children, but positive in children with ASD. The outcomes support the idea that a combination of poor emotion regulation and impaired understanding of others’ emotions is associated with aggressive behavior in children with ASD.     

Psychiatric symptoms in children and adolescents with higher functioning autism spectrum disorders on the Development and Well-Being Assessment

The Development and Well-Being Assessment (DAWBA) parent interview was used to assess psychiatric symptoms in children and adolescents with higher functioning autism spectrum disorders (ASD) (n = 60; age range 6.5–16.7) and in typically developing (TD) children and adolescents (n = 60; age range 6.9–16.2). Psychiatric symptoms were reported in the ASD group (68%) significantly more compared to the TD group (12%). Specifically, emotional disorders, attention deficit hyperactivity disorder/hyperkinesis, and tic disorders were significantly more frequent in the ASD group compared to the TD group. Routine screening and early identification of these symptoms could have important implications for planning interventions and thus outcome in individuals with higher functioning ASD. The DAWBA would be a useful interview for this purpose, since it can also be easily and quickly administered in clinics not specialized in psychiatry.     

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.     

Walking-induced muscle fatigue impairs postural control in adolescents with unilateral spastic cerebral palsy

BackgroundFatigue is likely to be an important limiting factor in adolescents with spastic cerebral palsy (CP).AimsTo determine the effects of walking-induced fatigue on postural control adjustments in adolescents with unilateral CP and their typically developing (TD) peers.MethodsTen adolescents with CP (14.2 ± 1.7 yr) and 10 age-, weight- and height-matched TD adolescents (14.1 ± 1.9 yr) walked for 15 min on a treadmill at their preferred walking speed. Before and after this task, voluntary strength capacity of knee extensors (MVC) and postural control were evaluated in 3 conditions: eyes open (EO), eyes closed (EC) and with dual cognitive task (EODT).ResultsAfter walking, MVC decreased significantly in CP (−11%, P < 0.05) but not in TD. The CoP area was only significantly increased in CP (90%, 34% and 60% for EO, EC and EODT conditions, respectively). The CoP length was significantly increased in the EO condition in CP and TD (20% and 21%) and was significantly increased in the EODT condition by 18% in CP only.ConclusionsUnlike TD adolescents, treadmill walking for 15 min at their preferred speed lead to significant knee extensor strength losses and impairments in postural control in adolescents with unilateral spastic CP.     

Nutritional deficiencies and overweight prevalence among children with autism spectrum disorder

Children with autism spectrum disorder (ASD) are at risk of developing nutritional deviations. Three to six year old children with ASD were compared to their typically developing siblings and to a typically developing age and gender matched control group, in order to evaluate their intake and body mass index.Nutrient intake was compared to the Dietary Reference Intake using three-day diet diaries completed by the parents. The sum percentage of nutritional deficiencies in the ASD group compared to the typical development group was 342.5% (±122.9%) vs. 275.9% (±106.8%), respectively (P = 0.026). A trend toward higher deficiency in the ASD group was observed as compared to the sibling group 363% (±122.9%) vs. 283.2% (±94.7%) (P = 0.071). A higher body mass index was found in the ASD group compared to their counterparts, despite their nutritional deficiencies. In conclusion, children with ASD are more likely to suffer from nutritional deficiencies despite higher body mass index.     

Effects of unilateral dysfunction of the inferior vestibular nerve system on postural stability

ObjectiveTo investigate whether disorders of the inferior vestibular nerve (IVN) system affect postural stability.MethodTwo-legged stance tasks were performed by patients with unilateral peripheral vestibulopathy (n = 108) in four conditions: eyes open or eyes closed, with or without foam rubber. We examined six parameters: the velocity of movement of the center of pressure and the envelopment area determined by tracing the movement in the eyes closed/foam rubber condition, Romberg’s ratio of velocity and area with foam rubber, and the foam ratios (ratios of a measured parameter with to without the foam rubber) of velocity and area with eyes closed.ResultsThe values of all six parameters were significantly higher in patients with unilateral vestibulopathy whose cervical vestibular evoked myogenic potentials (cVEMPs) were abnormal compared with healthy controls (p < 0.01). Four of the six parameters showed significantly higher values (p < 0.05) in patients with unilateral abnormal cVEMPs in the presence of normal caloric responses compared with the controls.ConclusionsFoam posturography is useful for making a preliminary assessment of unilateral vestibulopathy with abnormal cVEMPs. Selective damage of the unilateral IVN system could affect postural stability.SignificanceWe proved the influence of the disorder of the IVN system on postural stability.     

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.     

Self-esteem,social support,and life satisfaction in Chinese parents of children with autism spectrum disorder

PurposeThe current study examined self-esteem, social support, and life satisfaction in Chinese parents of children with autism spectrum disorder (ASD), and observed the mediation effects of social support on the relationship between self-esteem and life satisfaction.MethodsWe compared 118 Chinese parents of children with ASD to 122 demographic-matched parents of typically developing children on measures of self-esteem, social support, and life satisfaction using the Rosenberg Self-Esteem Scale (SES), Multidimensional Scale of Perceived Social Support (MSPSS), and Satisfaction with Life Scale (SWLS), respectively.ResultsParents of children with ASD scored significantly lower on self-esteem, social support, and life satisfaction than the controls (ps < 0.01), and social support partly mediated the relationship between self-esteem and life satisfaction in both groups. Hierarchical regressions indicated that after controlling for demographic variables, social support and self-esteem were significant predictors of life satisfaction in both groups but explained more variance in life satisfaction for the parents of children with ASD.ConclusionsSocial support and self-esteem play a more important role in life satisfaction for parents of children with ASD than those of typically developing children. Life satisfaction is positively related to higher household income, higher self-esteem, and stronger social support for parents. Self-esteem is likely to be associated with greater life satisfaction by means of greater social support. Future research and interventions should focus on fostering a more positive climate of social support for ASD families in China.