Module I: Description of Sensory and Motor Problems in Asperger’s Syndrome and Impact on Function

Fine Motor Problems:

It is apparent from case studies and first person accounts that fine motor problems can be very limiting to functional performance. As mentioned previously, one of the parents of a child initially described by Asperger, indicated that she felt her child’s difficulty with dressing was related to his clumsiness. Three other parents who have written about their children also indicate that their children with Asperger’s Syndrome had problems on tasks such as doing fasteners on clothing, learning to tie shoes, cutting meat, or spreading jam on bread.^{2, 5,7} Difficulty in hand writing is also quite common.^{1, 6,7,8,11} Asperger’s description of “Harro” states, “He carried on writing carelessly and messily, crossing out words, lines going up and down, the slant changing” (p.55).¹ One mother indicates that her son John’s handwriting was so poor the school refused to teach him cursive writing.⁶ Clearly, fine motor problems interfere with a child’s ability to learn common, everyday tasks. But we need to be more specific about the skills involved.

Many children with Asperger's Syndrome find the physical act of writing tedious and difficult

 

 

As an example, in his book about his own experiences living with Asperger’s Syndrome, Stephen Shore indicates he had problems with writing.⁸ In Shore’s case the problem with writing did not appear to be the result of any general clumsiness with his hands. He indicates that he often wondered why his writing in script was so poor when he had the manual dexterity to take apart a watch’s gears. To appreciate the complexity of a task such as writing, take a moment to try this exercise:

Therefore a complex task such as writing involves several abilities including a certain level of motor skill and practice, a visual spatial component and also the ability to learn and internalize the motor plan for each of the letters. For a person like Stephen, working at the motor skill level to help him improve his writing would not have been the most efficient or even the most helpful way to assist him. For Stephen Shore, the problem may well be in the area of the motor plan.

There are also other problems that have been reported to interfere with a child’s performance on fine motor tasks. Manjiviona and Prior¹⁶ noted that in six of their 21 children with Asperger’s Syndrome, the children would begin a task with the preferred hand, but would then swap hands in the middle of the task. Pyles ⁶ indicates that in her son’s early years, he had “midline difficulties”. That is, the child tended to use his right hand when working on the right side of the body and the left when working on the left side of the body and would attempt two-handed activities using only one hand. Being able to use two hands together is inherent in many tasks. As an example, think about how hard it would be to learn to tie your shoes if you could not efficiently coordinate the function of the two hands in this task.

Analyzing the task to determine where the skill is breaking down is necessary if remediation is to be directed at the component that is limiting function. One mother talks about the fact that at nine years of age her son with Asperger’s Syndrome was still not tying his shoelaces despite the fact that she had tried everything she could to teach him, including investing in videos, books and pretend shoes.⁴ Even his younger sister attempted to teach him this task. Finally the mother was able to obtain the help of the school occupational therapist and two days latter the child came home to happily demonstrate that he had learned to tie his shoes. The mother indicates that she felt badly that she had been unable to teach this skill herself, stating that if she had not been able to teach her daughter to tie her shoes four years earlier she would have felt like a “total wash out” as a mother. It is sad that this mother felt defeated by not being able to accomplish the task, but she should take credit for her persistence in trying to find someone who could analyze the problem and come up with a possible solution. With this done, a remedial program could be put into place to target the most direct route to solve the problem. We will talk more about evaluation in the next module.

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