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Motor Skills Disorder in Kids with ASD Level 1 [High-Functioning Autism]

"Is it common for children on the autism spectrum to be rather clumsy and to have problems with motor skills? If so, how can it be diagnosed/treated?"

Neurological in origin, Motor Skills Disorder (MSD) is a developmental disorder that impairs motor coordination in daily activities. Many kids with ASD or High-Functioning Autism (HFA) experience deficits in motor skills development, which often manifest as abnormal clumsiness (although it may not be major enough to be considered a disorder in and of itself).

MSD is a result of weak or disorganized connections in the brain, which then translates to trouble with motor coordination. Movements are performed because the brain sends messages to the area requiring action. MSD is a result of weak or poorly structured neural pathways to the moving parts of the body.



Clumsiness is a matter of poor balance and gross motor coordination. The origin of this deficit is the vestibular system of the inner ear. The vestibule is an organ responsible for maintaining balance and coordination and is located beside the cochlea, which acts as a sound receptor. Although they attend to different information, the proximity of the vestibule and cochlea allows them to work together. But, if one system is not functioning well, the other is concurrently affected.

ASD children with MSD tend to have an overly sensitive tactile system that causes them to perceive the most gentle touch as objectionable. They may also have a very low pain-threshold or an automatic reaction of fear when touched (i.e., “tactile defensiveness”). This is a result of a sensory processing disorder, which is a problem in the way the child’s brain interprets information received from the senses. This issue (similar to that of coordination) originates in the vestibule, because all sensory information is transmitted to the vestibule before being sent to the cerebellum (i.e., the part of the brain associated with movement).

Kids with MSD often suffer with low self-esteem resulting from poor ability to play sports and teasing by their peers. The disorder can be extremely disabling both at school and in everyday life due to impairment of functioning. Young people with this disorder are also at risk for obesity due to the higher rates of physical inactivity.

Kids with MSD have a variety of symptoms depending on the age of diagnosis. Infants may present with non-specific findings, such as floppy baby (i.e., hypotonia) or rigid baby (i.e., hypertonia), and may be delayed in their ability to sit, stand or walk. Toddlers may have difficulty feeding themselves. Older kids may have a hard time learning to hold a pencil, throw and catch a ball, ride a bike, place a drinking glass on the table without spilling the contents, etc.

As children with this disorder age, they often avoid physical activities, especially those requiring complex motor behaviors (e.g., sports, dancing, drawing, gymnastics, swimming, cycling, etc.). This is due to the child’s propensity to fall or trip more often than others and their inability to complete motor tasks adequately. These children may have more bruises or superficial skin injuries due to being "clumsy." They may often feel unable to judge spatial distances, have difficulty with shutting off faucets, turning off devices, and tend to have trouble putting together puzzles or toys.




Diagnosis—

If you suspect that your youngster may suffer from MSD, consult with your doctor. The first step in diagnosis is conducting a complete physical, neurological, and motor exam in order to determine that other movement or neuromuscular disorders are not causing the problems. During this exam, the doctor will ask you about various major developmental milestones to try to understand just how "lagging" your youngster's development may be. The doctor may refer you to a child neuropsychologist for more extensive assessment with some of the following tools:
  • The Bender Gestalt Test is used to assess visual-motor integration and visual perception skills (e.g., whether the eyes and the parts of the brain related to vision communicate with each other appropriately). This test consists of nine figures that the youngster must copy.
  • The Bruininks-Oseretsky Test of Motor Proficiency assesses the fine and gross motor skills of kids ages 4 to 14. These tasks often appeal to kids because they are similar to typical childhood activities (e.g., throwing and catching a ball, running, doing pushups, etc.). This test is the most widely used assessment of motor ability, and can be used on a wide range of young people, from able-bodied children to those with severe physical handicaps. 
  • Reitan-Indiana Neuropsychological Test Battery for Children, an assessment for kids ages 5-8 years, provides a measure of overall functioning and hones in on specific motor skills or impairments that may be present. A corresponding test for older kids (ages 9-14), the Halstead Neuropsychological Test Battery for Children, is also available.

Treatment—

Physical or occupational therapists can work with young people affected by MSD to develop and improve their physical skills and strengthen their muscles. Community-based services in the home or school-setting may also be beneficial. Also, "by-pass methods" can be used (i.e., special adaptations such as allowing an unlimited amount of time for HFA kids to take tests, providing modifications in requirements for handwriting, using specialty tools such as left-handed scissors, adaptive writing instruments that help these kids to achieve academic and occupational goals, etc.).

Targeted multi-sensory interventions include Sensory Integrative Therapy and Perceptual Motor Training:
  • Sensory Integrative Therapy teaches children how to properly absorb and sort information about sensory experiences (e.g., touch, body position, sound, how hard to bite down, how wide to open your mouth, etc.).
  • Perceptual Motor Training involves retraining the child's body to recognize and prioritize various sources of stimuli and respond accordingly (e.g., they may learn how to use certain muscle groups rather than others while walking or grasping things).

The course of MSD is unpredictable. For some autistic kids, the disorder essentially goes away after a while. For others, the lack of coordination continues through the teenage years and into young adulthood. Though early intervention is better than later intervention, treatment received as a grown-up can still help lessen the severity of symptoms.

 
Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Teaching ASD Children to Self-Manage Their Behavior

 "I need some useful behavior management strategies for a very out of control 6 yo boy with autism (high functioning). Thanks in advance!"

Teaching kids with ASD or High-Functioning Autism (HFA) to manage their own behavior allows parents to spend less time dealing with challenging behaviors at home. Managing your own behavior is called self-control. Self-control skills are used to help HFA children to pay attention to their own behavior. These young people can learn to monitor their own behavior and control their own actions through using self-control techniques. 

In order to help a child on the autism spectrum learn to monitor his own behavior, parents should ask themselves the following questions:
  • Are there any factors or challenges that my youngster faces that need to be considered before implementing a self-control plan?
  • Is my youngster able to make an accurate self-assessment of his behavior?
  • What goals do I have for my youngster in using a self-control plan?
  • What is it that interests or engages my youngster that may be used to begin a self-control program?
  • What is my youngster’s current level of self-control?



How to teach HFA children to manage their own behavior:

1. Parents should assess their youngster’s current level of self-control to accurately report on her behavior. For instance, the parent may ask the youngster as she sits watching television, “Did you pick up your dirty clothes and put them in the laundry basket?” If the parent has just seen that the dirty clothes have not been put in the basket, yet the child responds that she did put them in the basket, the parent will know that her youngster currently does not accurately “assess” her behavior.

It’s easier to have a child assess behaviors around activities in which she is currently engaged. Some kids may not be able to accurately assess their own behaviors and may need to be taught how to self-assess prior to using a self-control program. Parents may need to teach their child to correctly report if she did or didn’t perform a task that the parent asked about (e.g., doing chores, completing homework, etc.).

2. Parents can identify what observable behaviors they want their youngster to learn to self-manage. Each step needs to clearly describe what the youngster should do. For instance, your son may be taught that when told to “get ready for dinner,” he should stop playing computer games, wash his hands, and take a seat at the dinner table.

3.  Once the behaviors have been identified, they are visually displayed for the youngster using photographs or drawings on a poster. The youngster is given a way to monitor her behaviors using a checklist or chart that shows the activity with a place to indicate whether she performed the step correctly (using a check mark, smiley face, sticker, thumbs up/thumbs down, etc.). Parents can laminate the chart or checklist and use a wipe-off marker so that it is reusable.

The goal of the chart or checklist is to teach the youngster how to independently engage in appropriate behavior – not to punish or withhold activities. It can be used to chart special activities that the youngster earns. Oftentimes, kids on the autism spectrum respond well to the use of an earned “special” activity if they complete the chart (e.g., having time on the computer). If the self-control chart includes a special activity, the youngster can choose the special activity. A visual representation (e.g., a photo or picture cut out from a catalog or magazine) of the special activity can then be placed on the chart as a reminder of what the youngster can earn when the chart is complete.

4.  The youngster is taught to engage in the desired behaviors and then to monitor his performance. Once the chart is prepared, the parent should review the chart with the youngster after the activity has occurred. The parent can review the steps that are listed on the chart and explain how the youngster’s performance will be marked (e.g., “The first picture shows ‘I put my dirty clothes in the laundry basket’. If you put your clothes in the basket, we are going to place a smiley face on the chart. If you did not put your clothes in the basket, we will not place a smiley face on the chart. Let’s see what happened. Did you put your clothes in the basket? Yes, you did. We can put a smiley face on the chart.”).

Once parents have reviewed the system with the youngster and they believe the youngster understands it, they should try it out the next time the activity occurs. During the activity, parents can remind their youngster of the behaviors on the chart. When the activity is over, they can help him mark the chart.

5.  Parents should provide positive attention or feedback to their youngster while she is learning self-control. When parents give their youngster feedback for using the chart, they should praise her for engaging in the behavior and the accuracy of her ability to self-manage. Over time, parents can gradually provide less assistance for using the chart. The goal will be to get the youngster to use the chart independently until she does the behavior easily and no longer needs the self-control system.

Self-control skills are designed to teach autistic kids how to engage in appropriate behavior, independently. Over time, parents should decrease their assistance and support their child to use self-control skills independently. If the youngster misses a step or does not complete the chart, parents can gently redirect him to complete the step and encourage him to try harder the following day or during the next activity.

When methods to teach self-control skills are carefully implemented, positive changes in behavior can be expected. Self-control skills are most effective when parents implement the self-control program systematically and monitor their youngster’s progress. When an autistic youngster has difficulty with the process or is not making progress, the self-control system should be reviewed, and additional instruction or new procedures should be implemented.





Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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