Module II: Assessment of Sensory Motor Problems in Asperger’s Syndrome

Part I: Issues Pertaining to Assessment

Introduction

As we have seen in Module I, many people with Asperger’s Syndrome have sensory and motor problems. We have also seen how these problems can have an impact on social, academic, vocational, and recreational or leisure time activities. This module will explore information about the identification and assessment of these sensory and motor issues. Procedures, methods and examples of major assessment tools will be discussed. Pertinent issues and complexities involved in the assessment of sensory and motor problems in the Asperger’s population will also be covered.

Let's take a hypothetical situation that many teachers in a typical elementary school might encounter.

Mrs. Knolls, Susan’s second grade teacher, had been concerned about Susan for some time. Susan seemed preoccupied with unicorns and kept a small replica of a unicorn with her at all times. She seemed to have little contact with the other children in the class. She could be particularly disruptive during writing tasks, constantly fidgeting in her seat. She appeared to have difficulty with writing and used an awkward hand grasp on the pencil. Her work was often illegible. Even in warm weather, Susan always wore a blouse or shirt with long sleeves and kept pulling them down over her hands. She often complains that the class is too noisy and puts her hands over her ears. When observed in the gym or playground, her movements appeared particularly clumsy.

All of these observations bothered Mrs. Knolls, but she was particularly concerned by an incident she observed on the playground. On this morning Susan had joined a group of child running around playing tag. Although she appeared to be engaging with the group, she only appeared to be running around for the joy of running rather than playing with a purpose. She also ran at a fairly slow pace for her age.

At one point in this play, one of the other children came up behind Susan to tag her. Susan looked startled, then screamed: “you are trying to strangle me.”

This was quite upsetting to Mrs. Knolls. This behavior appeared so out of character and she could not understand why Susan had reacted the way she did. The other children become upset and frightened. The child, who was accused of strangling Susan, became angry and reported this incident to her parents later that day. Mrs. Knolls received a call from the parents, requesting an explanation. What should she do?

Attempting to support Susan and the other children after this outburst is no simple or easy matter. Mrs Knolls is aware that Susan was just recently diagnosed with Asperger’s Syndrome. Many individuals with Asperger’s have difficulty with social interactions, are slow to respond physically and show emotional vulnerability. Mrs Knolls is also aware that Susan has just begun to receive services from the school psychologist to address behavioral problems. Her initial response as a teacher might be to call the school the psychologist to help identify the problem and remedy the situation.

If the school psychologist that Ms. Knolls called conducted a behavioral assessment, one explanation of Susan’s behavior on the playground might be that Susan does not understand non-verbal social interactions and social rules. Therefore, the specialist conducting the behavioral assessment might intervene by developing a program to help provide the social skills Susan would need to enter into a game of tag.

Intervention strategies based on behavioral observations are often very helpful and necessary to address such issues. However, developing only a behaviorally based approach may miss sensory and/or motor deficits. For example, no matter how many times you might teach the social rules of how to play the game of tag, Susan might still respond negatively when she is tagged because she is still overly sensitive to other’s touching her. She also might still be frustrated because she is a slow runner and can not move her body quickly enough to avoid being tagged. A sensory motor assessment, in addition to the behavioral assessment, would allow the teacher and staff involved to understand the roots of Susan’s behavior more fully, and therefore have a better chance at bringing about a solution that works for everyone.

An occupational therapist trained in the assessment of disorders of sensory integration (DSI) would be the most likely professional to assist with this initial step in a sensory motor assessment. Sensory integration is a theory and an intervention approach that is based on the understanding of underlying neurological mechanisms that effects behavior, learning and motor skills. This will be discussed more fully in module III. The occupational therapist should also have experience, special training, and/or certification in the assessment of disorders of sensory integration. (For more information about the training of occupational therapists in assessment and intervention of disorders of sensory integration, see Formal Test and Measures section, later in this module.)

Dr. Larry Silver, M.D., writes: “As a professional who sees many children and adolescents with learning, language and sensory integration problems, I see clearly that critical to any progress is helping parents understand the underlying neurological problems. Without their knowledge of the brain difficulties and the resulting school and life skill problems, they cannot understand or help their son or daughter as much as they want to.” (p. xv). ¹

Gathering initial information about Susan’s sensory and motor issues might include asking leading questions to better understand her vulnerability and disruptive behaviors. Examples of questions asked might be: Is Susan sensitive to unexpected or light touch to her skin? Does she recoil if touched unexpectedly on her back? Is she bothered by noise that other children are able to ignore? Does she bump into things easily, or tends to lean a lot into walls or on a table surface. Can Susan learn new motor skills as easily as other children, (e.g. skipping, jumping jacks or jump rope) or is she slow to learn these tasks, or unable to do them at all?

Let’s reconsider the case of Susan, now that initial information for the teacher is available. If appropriate, a more formal assessment might take place to pinpoint specific difficulties and develop a baseline of information from which to determine the need for intervention. From the results of this assessment, Susan’s teacher would have a more thorough understanding of why Susan was responding the way she did during the game of tag, as well as to other classroom and school activities. She would learn that touch sensations that others would not normally react to, could be unusually irritating to Susan. It would be possible that Susan became so overly sensitive to touch that any sudden, imposed touch such as received during a fun game of tag might result in an emotional outburst. This outburst might be her strategy to protect herself.

(Note: Some younger individuals who are overly sensitive to touch might respond in a physically aggressive manner, such as hitting or pushing the other child. However, since Susan has Asperger’s Syndrome and is older, she might be more likely to respond in a verbally aggressive manner than a physically aggressive manner to protect herself.)

Susan’s need to wear long sleeves in spite of the hot weather might be a way to cover and protect her arms from uncomfortable touch sensation. In addition, Susan might shy away from groups of other children due to the likelihood of being bumped or touched accidentally.

Susan appears to be a girl who likes excessive movement stimulation so running around in the playground might give that kind of input to her. She may also like some forms of touch stimulation of her choosing, so fidgeting with an object, such as a unicorn, might provide sensory feedback to her hands and fingers. Susan could be sensitive to repetitive background noises such as a fan or fluorescent light. Just as certain forms of touch sensation results in irritability, these noise sensations might result in a similar state of irritability.

Susan’s teacher and parents might also learn that Susan has low postural muscle tone that results in slight muscle weakness and lack of muscle persistence. That is, her muscles may only be able to hold contractions for brief periods of time before fatigue sets in. As a result, she might need to lean against walls to find support or find it difficult to stay upright in a chair for long periods of time when at her desk. Therefore, she needs to get up constantly to give her body more movement stimulation. Weakness in her hand and finger muscles might also result in an awkward grasp on the pencil.

The assessment information would also provide information about Susan’s poor motor planning abilities and motor coordination. (To learn more about motor planning, go to Module III). Her teacher and family would now understand that due to poor motor planning, Susan has difficulty responding quickly to change directions during fast moving physical games such as tag. Poor motor planning might also add to the slowness and illegibility of her writing because she might need to think about each move of the pencil while forming letters. New or complex movements may not come automatically to Susan. If she’s trying to learn a new movement, such as skipping or jumping jacks, she might require constant repetition, a step by step approach, and more time than others to learn the movements.

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