Module III: Intervention of Sensory and Motor Issues in Individuals with Asperger’s Syndrome

Integration of Sensory Information for Skill Development

In this section we will look at what happens when all of the information sent into our system both internally and externally from the environment come together and work as a team. The connections made in the systems and between the systems are all receiving information and communicating with one another to help us achieve certain skills. We will look at praxis, bilateral integration and sequencing, postural control and stability, fine motor skill development, visual perception, and visual-motor integration.

Praxis (Motor Planning)

Motor planning entails first coming up with an idea of what to do with something, what to say to somebody, or how to move your body. Once we come up with an idea, we have to develop a plan of what to do. Finally we sequence, organize and execute the plan. ^{1, 3}

Let’s take an example of how we motor plan through an activity. Learning how to drive a car is probably something that most of us remember doing. The first part of motor planning is ideation. We first have to get the idea in our heads that this car would “go” and that it would take us places if we could figure out how it worked. We could have come up with this idea by watching other people driving cars, by looking at pictures, or by hearing about the car. We then had to come up with an idea of what to do with all of the things inside of the car such as the clutch, the stick shift, the brake, the accelerator, the blinkers, etc. We might play around with the different new objects on the car that we had only glimpsed from the back seat. Once we had an idea about what everything in the car might be capable of doing, we had to come up with a plan of action. Our plan would be entering the car, starting the car, adjusting what needed to be adjusted, and driving! Simple right? Wrong! After the plan, we then had to sequence through the different steps involved with each part of the plan and execute them safely and effectively.

The end result would be that we would unlock the car door and open it. We would then sit in the seat and adjust it so our feet comfortably touched the pedals. Then we would adjust all of the mirrors and the steering wheel of the car. After this, we would put our feet on the clutch and the brake and then put the key in the ignition and turn it. We would then be able to maneuver the stick shift to the reverse position and ease up on the clutch while pressing down on the accelerator in a nice balance to make the car go without stalling out. Once that’s accomplished, we would then put our feet back on the clutch and shift gears with our hands to first gear. Then again we would ease up on the clutch as we press on the accelerator to make the car go. This is the way it would go as we shifted up and down and drove our car through traffic.

For people who drive stick shift cars, this is an example of something that they do everyday with ease and without thinking too much about it. When first learning, they may have had to go through each step and practice each step individually. They would get feedback from the car about whether or not they were shifting appropriately. The car would stall when the balance was not found between the clutch and the accelerator. They would also get the feedback of how hard they had to press on the accelerator in order to make the car go and how hard to press on the brake to make it stop. They would learn how much to turn the steering wheel so as to go left or right and how to slightly adjust the wheel to go straight.

This was not the way that I remember this task. Let me share what it was like for me to learn how to drive as a teenager. Although I do not have Asperger’s Syndrome, I do have a variety of sensory integration difficulties, particularly in the area of praxis. For me, it didn’t matter how much feedback I got, I could not figure out how to work a stick shift car and to this day, I will not drive anything but an automatic. It took a lot of effort for me to determine how much force I needed to use on the pedals and when to shift gears. I also had a hard time getting the stick in the right position for the correct gear. These tasks never became automatic for me. I remember my father sitting next to me saying “Don’t you feel it, now ease up on the clutch – no wait, too fast, we’re going to stall.” I would get so anxious driving with other cars because I was afraid they would beep at me or get annoyed with me because I could not get it right. For a long time I avoided driving altogether and was very happy to have my parents drive me around. I finally did get my license after much practice and after I hit the point of desperation. I still have to concentrate very intently on driving and cannot usually do anything else while I am driving. I still think about the steps involved with changing lanes, braking, and accelerating. People still tell me I have a “heavy foot”.

People with Asperger’s Syndrome often display similar difficulties with motor planning. This often causes them to avoid new motor tasks or challenges or have great anxiety around new or novel situations. They often respond by trying to control the situation and may be very rigid with their plans. If changes occur unexpectedly, this will often upset the person because he or she has not gotten the right feedback to do things naturally. Often people with Asperger’s Syndrome will give up trying activities that have more complex motor tasks and therefore they are not getting the feedback they so desperately need. I hope that you can see from this example how complicated motor planning is for some people who find it difficult and how a lot of us take for granted the ease with which we complete tasks such as dressing, completing assignments, driving, etc. Tony Attwood talks about children, adolescents and adults experiencing difficulty with locomotion, ball skills, balance, manual dexterity, handwriting, rapid alternating movements with hands and feet, lax joints, and rhythm². All of these contribute to or are a product of motor planning.

Bilateral Integration and Sequencing

From very early on, we learn to use our body and appendages first together and then separately, as separate moving parts. When babies are born, they tend to use their whole bodies together. For example, one foot does not come up in the air, both feet come together when lifting them off of a surface. Two hands come to mouth instead of just one. The head tends to move with the body in whatever direction it begins to move. Very quickly, however, babies begin separating their bodies out into separate moving and working parts. The head moves separately from the body and the eyes eventually can move left, right, up and down without the head moving as well. They start to reach with one hand or the other, one foot or leg will come up and over in preparation for rolling. Eventually, babies will begin to put their hands out and their legs out when on their bellies and move in a “swimming” motion, first with arms together and feet together and then separating the parts. They then may go onto all fours and rock back and forth before they begin to move in an alternating manner with arms and legs in a crawling motion. Thus, bilateral integration is developing! This becomes extraordinarily important as children grow and develop. It helps them establish a rhythm to their movements, stabilize one part of the body while the other is moving (such as is needed for handwriting, fine motor tasks, gross motor tasks), move the body in alternating patterns for walking, swimming, or performing sports and gross motor activities, and move safely, smoothly, and effectively through the environment.^{1, 3}

Postural Control and Stability

Postural control and stability begins to develop in the womb. The fetus will stretch out muscles, contract other muscles, roll around, and kick out arms and legs. This is all occurring without gravity as a factor. When the baby is born, he or she must then begin to move against gravity. When developed properly, the stomach and back muscles work together in synchrony and provide a person with a stable base to stand and sit and move around.¹ Good postural control and stability allow us to sit upright in a chair for prolonged periods of time, protect ourselves when falling or performing complex gross motor activities, and to automatically right our bodies when we are displaced on a moving surface. Adequate postural control also sets us up for performing fine motor skills. Consider the difficulties that children and adolescents with Asperger’s Syndrome face when trying to maintain an upright seated position during fine motor work, dining, or listening. They often have great difficulty sitting still in their seats, often shifting their position or getting up out of their seats to move around. Sometimes children or adolescents with Asperger’s Syndrome will slump in their seats or rest on their arms when challenged to sit for extended periods of time. On the playground, they may appear weaker than other children their age and may run out of steam faster during gross motor activities.^{2, 5}

Fine Motor Skill Development

Strong fine motor skill development allows us to use the small muscles in our hands to manipulate different objects, both small and large. This occurs after we can maintain a stable sitting position, shoulder position, and arm position. It allows us to dress ourselves, open containers, pick up and deposit small objects, create different projects, cut with scissors, and use eating and writing utensils. Many children with Asperger’s Syndrome avoid or experience challenges around fine motor activities. They may find it hard to button, snap and zipper clothing and to hold writing or eating utensils correctly. This can impact a variety of skills including dressing, eating, social etiquette, and academic achievement. ^{2, 5}

Visual Perception/Visual-Motor Integration

When our eyes are perceiving sensory input appropriately, we can learn about its size, shape, color, etc. We are able to find objects hidden in the background, such as at a grocery store; we are able to determine how far an object is from another one; we can see how different pieces come together to make a whole; we can see objects in our periphery when driving or riding a bike and focus on objects in our paths as well. When we put this together with motor skills, the outcome is visual-motor integration. This is important for the development of handwriting skills, eye hand coordination, and safe movement through space both on one’s feet or on a bicycle, scooter, car, etc. Children and adolescents with Apserger’s Syndrome are usually considered to be highly visual individuals meaning that they are drawn to visual stimuli and activities and usually are very successful with these activities. They have a harder time, however, with visual-motor integration tasks such as drawing, copying, and writing. This can cause frustration and difficulties as the demands of education continue to increase with higher-grade levels and expectations.

Kenneth Hall, a young man with Asperger’s Syndrome writes: “One of the things that caused trouble was when I refused to handwrite. This caused problems till I was nine…I still hate handwriting. It is usually boring and pointless, but then this is true for a lot of things adults try to get children to do”(p. 20).⁴
{Click on the thumbnail images below to view handwriting samples}

Handwriting Samples
     

Please view the following chart adapted from Williams, K. in his book Understanding the Student with Asperger's Syndrome Click on the appropriate icon for either Microsoft Word or Adobe Acrobat (PDF) format.You will need Adobe's free Acrobat Reader if you choose PDF format.:
  

Now that we know about the different sensory systems, and the outcome of strong sensory integration skills, we can discuss the intervention process for children and adults who have difficulty processing sensory information.

Previous | Next