Sensory Modulation in Children with Developmental Coordination Disorder Compared to Autism Spectrum Disorder and Typically Developing Children

Sensory-movement underpinnings of lifelong neurodivergence: getting a grip on autism

While the autism diagnosis emphasizes "deficits" in social communication, the article advances that sensory-movement differences underpin autism through a review of the following sources of evidence. This account critically challenges "autistic regression", with evidence that sensory-movement features appear by birth as the earliest signs of autism and underlie the behavioral differences used for diagnosis, which may reflect adaptations to inherent differences and misunderstandings from others. Sensory and motor differences are salient to autistic people, but they often go underrecognized by others. They cause cascading effects in infancy on behavior and communication through differences in sensorimotor learning, automatic imitation, eye contact, sensory perception, and interests. The article then explains how sensory processing differences may influence reduced perceptual narrowing, which involves a bottom-up information processing style grounded in the surrounding environment. Furthermore, this bottom-up processing may grow from reduced sensory integration in feedback loops potentially involving the cerebellum of the brain. The article then moves into implications for the widespread consequences of these inherent differences on quality of life. The article closes with implications for autism as a construct (including underestimated empathy and pain), testing the theory, providing sensory-sensitive support and acceptance of autistic people, and applications to diverse autistic people. The theory may apply particularly well to autistic women and girls, autistic people with speech divergence, autistic people with ADHD, and autistic people with co-occurring sensory and motor-related neurodivergences. Throughout the article, the theory also provides clinical, neurological, and experiential evidence for sensory and motor differences as lifelong, challenging the notion of "losing" (an) autism (diagnosis) as instead reflecting (risky and not necessarily "successful") camouflaging.

Motor Signature Differences Between Autism Spectrum Disorder and Developmental Coordination Disorder, and Their Neural Mechanisms

Autism spectrum disorder (ASD) and Developmental Coordination Disorder (DCD) are distinct clinical groups with overlapping motor features. We attempted to (1) differentiate children with ASD from those with DCD, and from those typically developing (TD) (ages 8-17; 18 ASD, 16 DCD, 20 TD) using a 5-min coloring game on a smart tablet and (2) identify neural correlates of these differences. We utilized standardized behavioral motor assessments (e.g. fine motor, gross motor, and balance skills) and video recordings of a smart tablet task to capture any visible motor, behavioral, posture, or engagement differences. We employed machine learning analytics of motor kinematics during a 5-min coloring game on a smart tablet. Imaging data was captured using functional magnetic resonance imaging (fMRI) during action production tasks. While subject-rated motor assessments could not differentiate the two clinical groups, machine learning computational analysis provided good predictive discrimination: between TD and ASD (76% accuracy), TD and DCD (78% accuracy), and ASD and DCD (71% accuracy). Two kinematic markers which strongly drove categorization were significantly correlated with cerebellar activity. Findings demonstrate unique neuromotor patterns between ASD and DCD relate to cerebellar function and present a promising route for computational techniques in early identification. These are promising preliminary results that warrant replication with larger samples.

Examining the Effectiveness of Ayres Sensory Integration® Intervention for Children With Developmental Coordination Disorder in Improving Motor Coordination and Daily Activity Function: A Randomized Controlled Trial

Background Ayres Sensory Integration® (ASI) intervention focuses on developing sensory processing abilities to improve motor coordination, executive functions, participation, and satisfaction in everyday activities. No well-designed research studies have addressed clearly the effectiveness of ASI intervention for children with developmental coordination disorder (DCD) even though ASI intervention was effective for children with autism spectrum disorders. Methods and procedures Seventeen children with DCD (aged 4-8.5 years old) were randomly assigned to either an intervention or a control group. ASI intervention was provided to the intervention group twice a week for 10 weeks. In addition to participants' goals in daily activities, sensory integration abilities and motor coordination were assessed before and after the intervention. Outcomes and results The split-plot factorial design demonstrated significant time × group interaction in the total score (F (1, 15) = 7.651, p = 0.014, partial η2= 0.338) and balance score (F (1, 15) = 11.163, p = 0.004, partial η2 = 0.427) of the Movement Assessment Battery for Children-Second Edition (MABC-2), with significant differences in simple main effects before and after intervention for the intervention group. The post-intervention Goal Attainment Scale (GAS) score showed a significant difference in the time × group interaction (F (1, 15) = 15.662, p = 0.001, partial η2 = 0.511) and a simple main effect in the intervention group. Conclusions A short-term, intensive ASI intervention improves motor performance, coordination, and daily activities function in children with DCD.

Understanding Mechanisms that Maintain Social Anxiety Disorder in Autistic Individuals Through the Clark and Wells (1995) Model and Beyond: A Systematic Review

Given the high co-occurrence of social anxiety in autism, no reviews to date have explored how cognitive and behavioural mechanisms identified to maintain social anxiety in non-autistic individuals may operate in autistic individuals. This systematic review evaluated: (1) empirical evidence underlying the Clark and Wells (1995) Cognitive Model of Social Anxiety in autistic individuals; (2) how vulnerability factors identified from autism literature (beyond core autistic traits) may be associated with social anxiety beyond the cognitive model. Published peer-reviewed English articles until 27th November 2023 were retrieved from PubMed, EMBASE, Ovid MEDLINE and PsycINFO. Quality appraisal and risk of bias were assessed using The Standard Quality Assessment Criteria for Evaluating Primary Research papers from a Variety of Fields tool. 47 articles met full inclusion criteria and included autistic individuals (with clinical diagnosis), a measure of social anxiety, and a mechanism outlined by either (or both) research questions. The majority of the 3340 participants across studies were male without intellectual disability, White/Caucasian, with 7 studies reporting an average age above 30 years old. Most studies used only self-report measures that may have inflated associations observed between social anxiety and mechanisms. All studies employed cross-sectional design, and no causality inferences could be drawn. Methodological issues around potential construct overlaps between social anxiety and autistic traits are highlighted. Overall, there is evidence in support of the as reported by Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model, as greater fear of negative evaluation from others, use of safety behaviours and somatic symptoms, and peer victimisation were associated with greater social anxiety. The review contributes evidence in support of autism specific contextual, predisposing/antecedent and maintenance factors of social anxiety beyond the original Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model. Given the potential for considerable heterogeneity for each highlighted process at an individual level across autistic individuals, clinicians can broaden formulation conversations with autistic clients to understand how autism related factors may influence the development and maintenance of social anxiety symptoms when applying and adapting the Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model.

Association Between Television Viewing and Sensory Reactivity in Childhood: The Cross-Sectional InProS Study

BACKGROUND

Current evidence suggests a potential detrimental effect of increased television viewing on children's health, including sensory processing issues. Therefore, this study examined the association between television viewing time and atypical sensory reactivity (SR) in children aged from three to seven years.

METHODS

We evaluated data from the InProS cross-sectional study (n = 545). Daily television viewing was categorized into tertiles: ≤1.5, 1.5 to 2.5, and ≥2.5 hours. SR was evaluated using the Short Sensory Profile (SSP). Children with atypical SR were those with a global SSP score below 155, 30 for tactile sensitivity, 15 for taste/olfactory sensitivity, 13 for movement sensitivity, 27 for under-responsive/seeks sensation, 23 for auditory filtering, 26 for low energy/weak, and 19 for visual/auditory sensitivity. We used multiple Poisson regression models with robust variance to explore associations.

RESULTS

After adjusting for covariates, children who watched television 1.5 to 2.5 and ≥2.5 hours/day showed a higher prevalence of atypical global SR (prevalence ratio [PR]: 1.54; 95% confidence interval [CI]: 1.03 to 2.30; PR: 1.81; 95% CI: 1.19 to 2.76, respectively) and auditory filtering (PR: 1.50; 95% CI: 1.15 to 1.96; PR: 1.36; 95% CI: 1.01 to 1.83, respectively), compared with children who watched ≤1.5 hours/day. In addition, watching television ≥2.5 hours/day, compared with watching ≤1.5 hours/day, was associated with having atypical SR in movement sensitivity (PR: 1.73; 95% CI: 1.06 to 2.83), under-responsive/seeks sensation (PR: 1.31; 95% CI: 1.02 to1.69), and low energy/weak (PR: 2.02; 95% CI: 1.01 to 4.06).

CONCLUSIONS

The findings showed that television viewing ≥1.5 hours/day was associated with a higher prevalence of atypical SR in childhood. However, further longitudinal studies are required to confirm these results.

Effect of physical activity on social communication impairments in children with autism spectrum disorder: A meta-analysis

This meta-analysis aims to systematically evaluate if different physical activities (PA) improve the social communication impairments (SCI) seen in children with autism spectrum disorder (ASD). For this meta-analysis, five databases (Web of Science, PubMed and Cochrane Library database in English, and CNKI and Wanfang Data Knowledge Service Platform in Chinese) were searched from database inception to September 11, 2024. The eligibility criteria included (1) study population comprised children with ASD, with no gender restriction; (2) experimental group consisted of a PA intervention; (3) control group consisted of nonPA interventions or routine activities; (4) outcomes were assessed using validated SCI scales (e.g., social cognition, social motivation, and/or social awareness); and (5) study design involved a randomized parallel group design. The quality of the evidence for each study was assessed using the Cochrane Risk of Bias tool. From a pool of 2714 potentially relevant articles, 17 were eligible for inclusion in this review. The results of overall response of PA intervention to SCI illustrated a Medium degree of statistical heterogeneity between studies (I2 = 53.3 %, p < 0.01); the effect size of PA intervention on SCI (expressed as standardized mean difference) was -0.34 (95 % CI: -0.57, -0.11), which was statistically significant. SCI of autistic children could be potentially improved by PA interventions, though further research is needed to clarify if benefits achieve clinical significance in addition to statistical significance. Proper design of PA interventions (45-90 min per session, more than 3 times per week and for 8-12 weeks) may enhance their effectiveness in treating SCI in children with ASD.

Atypical Sensory Processing in Neurodevelopmental Disorders: Clinical Phenotypes in Preschool-Aged Children

BACKGROUND

Sensory processing issues are frequent in neurodevelopmental disorders (NDDs), with very variable prevalence rates ranging from 20% to 95%. This study aimed to investigate sensory processing in preschool-aged children with NDDs, to clarify the epidemiology, and to identify associated or correlated clinical and psychometric variables.

METHODS

A total of 141 NDD children (age range 2-5 years old) were included and enrolled in two subgroups: 72 with ASD and 69 with other NDDs. A standardized neuropsychological evaluation was assessed (Griffiths III/WPPSI-III/Leiter-R, ADOS-2) and the parents completed the CBCL ½-5, the SPM-P, and the ADI-R.

RESULTS

Atypical sensory processing was reported in 39.7% of the total sample, more frequently in ASD (44.4%) than in other NDDs (34.8%). No statistically significant differences were found regarding gender and developmental level. A positive correlation was found between sensory processing abnormalities and behavioral problems (p < 0.01).

CONCLUSIONS

Compared to other NDDs, ASDs more frequently have atypical sensory processing and appear to present a specific vulnerability in the processing of proprioceptive and vestibular inputs. Our results suggest that sensory processing difficulties should be considered regardless of developmental level and in children with behavioral problems.

Exploring the presence and impact of sensory differences in children with Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) can experience sensory differences. There has been limited exploration of these differences and their impact on children with DCD.

AIMS

i) To explore the presence and impact of sensory differences in children with DCD compared to children without DCD; ii) To examine whether sensory differences are related to motor ability, attention deficit hyperactivity disorder (ADHD), or autistic traits.

METHOD

Parents of children (8-12 years) with (n = 23) and without (n = 33) DCD used standardised questionnaires to report on their children's sensory differences, autistic traits, and ADHD traits. Motor abilities were assessed through the Movement Assessment Battery for Children-2. Data were explored both categorically (between-groups) and dimensionally.

RESULTS

Children with DCD had significantly higher levels of sensory differences than children without DCD. Sensory differences also had a significantly greater impact on daily activities for children with DCD. Higher levels of ADHD and autistic traits, but not motor ability, were significant independent predictors of higher levels of sensory difference.

CONCLUSION

Children with DCD experience high levels of sensory differences, which impact on their daily lives. These sensory differences may be a marker for additional neurodivergence in children with DCD. Practitioners should consider the sensory needs of children with DCD.

WHAT THIS PAPER ADDS

This paper provides insight into the sensory features of children with DCD and the impact that sensory differences can have on daily living. Using parent-report, we found that children with DCD had increased sensory differences relative to children without DCD. These included increased hyperresponsiveness, increased hyporesponsiveness, and increased sensory interests, repetitions, and seeking behaviours (SIRS). We also found that sensory differences had a greater impact on daily living for children with DCD compared to children without DCD. Across the whole sample, autistic traits predicted hyperresponsivity and hyporesponsivity patterns; whereas traits of hyperactivity and impulsivity predicted SIRS. Motor abilities did not uniquely predict sensory differences, suggesting that other traits of neurodivergence may contribute to the sensory differences in DCD. Taken together, these findings highlight the necessity of considering sensory needs when supporting children with DCD. They also suggest that if sensory differences are identified in children with DCD, it may be due to the presence of co-occurring neurodivergent traits or conditions.

Motor deficits in autism differ from that of developmental coordination disorder

LAY ABSTRACT

A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.

Social responsiveness in children with developmental coordination disorder

BACKGROUND

Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized by deficits in performing motor tasks. Research suggests social skills are also altered.

OBJECTIVE

To investigate (1) whether the presence of DCD affects social responsiveness, (2) whether the co-occurrence of autism spectrum disorder (ASD) affects social responsiveness in children with DCD, and (3) whether there is an association between motor performance and social responsiveness in children with DCD.

METHODS

Based on parental reports, children aged 5 to 15.5 years were assigned to one of three groups: DCD only (noASD, n = 67), DCD and suspected ASD (sASD, n = 13), and DCD and confirmed ASD (cASD, n = 22). Parental answers to the Social Responsiveness Scale (SRS-2) and the DCD-Questionnaire (DCD-Q) were compared to norm values using one sample t-tests, and between groups using ANOVA and MANOVA. Pearson correlation coefficients explored the relationship between the SRS-2 and DCD-Q in the total group and per group.

RESULTS

Compared to norm values, difficulties in all areas of social responsiveness were reported in children with DCD, regardless of group (p<0.001). Compared to the noASD group, more unfavorable SRS-2 total T-scores and poorer DCD-Q scores were observed in sASD and cASD groups. Only in the total group, motor performance showed significant weak to moderate associations with the SRS-2 total T-score and all subscales except for 'social motivation' (r=-0.306 to -0.405; p ≤ 0.02).

CONCLUSION

Social responsiveness difficulties are more common in children with DCD and are more severe in the ASD groups. Motor performance and social responsiveness are weak to moderately associated.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05092893 (https://clinicaltrials.gov/study/NCT05092893).