Ideational Praxis, Play, and Playfulness: A Cross-Sectional Study of Autistic Children.

IMPORTANCE: Assessment of praxis skills is an essential aspect of understanding autistic children's development of play and playfulness. OBJECTIVE: To assess the relationship and influence of ideational praxis skills on play skills and playfulness among autistic children. DESIGN: A cross-sectional study. SETTINGS: Homes, schools, and early care centers across Spain. PARTICIPANTS: Children ages 4 yr 6 mo to 6 yr 11 mo (45 typically developing [TP] and 45 with autism spectrum disorder [ASD]). OUTCOMES AND MEASURES: Student's t tests were used to compare means between the two groups. Pearson's correlation and multiple linear regression were used to determine possible effects of ideational skills on play and playfulness. RESULTS: Scores for the TP group were significantly higher than those of the ASD group on all play dimensions-space management, t(88) = 4.58; material management, t(88) = 5.86; pretense-symbolism, t(88) = 8.12; and participation, t(88) = 7.31-and on the Test of Playfulness (ToP), t(88) = 10.18, and Test of Ideational Praxis (TIP), t(88) = 4.38 (all ps < .001). Multiple linear regression revealed a statistically significant effect of TIP dimensions-space management, F(3, 41) = 4.83, p < .042; material management, F(3.41) = 8.49. p < .001; pretense-symbolism, F(3, 41) = 5.66. p < .002; and participation, F(3.41) = 7.81. p < .001-and on the ToP, F(3, 41) = 5.96. p < .002. CONCLUSIONS AND RELEVANCE: Ideational praxis skills combined with diagnostic information significantly predicted play skills and playfulness, highlighting the influence of ideation on play. Plain-Language Summary: This article provides data supporting the influence of ideational praxis skills on the play skills and playfulness of autistic children. Understanding how ideational praxis skills affect the ability to recognize and act on object affordances might promote greater possibilities for play interactions among autistic children.

Exploring the Prognosis: A Longitudinal Follow-Up Study of Children with Sensory Processing Challenges 8-32 Years Later.

Sensory integration and processing challenges have been long recognized in children and, more recently, in adults. To understand the long-term prognosis of these challenges, more research is needed on what children with sensory integration and processing challenges look like as adults. Using the Adult/Adolescent Sensory History, researchers followed up with 102 adults who had known sensory integration and processing challenges as children to examine the following questions: What is the current sensory processing status of adults who received sensory-integration-based occupational therapy services as children? And how has the sensory processing status of adults who received sensory-integration-based services changed since childhood? This study compared performance on sensory processing measures completed as children and as adults for a follow-up group of adults. The results revealed that the severity of sensory integration and processing challenges experienced by the follow-up group decreased from childhood, with 51% of the follow-up group now scoring in the "typical" range of sensory processing. Our findings suggest that those children with sensory integration and processing challenges who are recognized and seek occupational therapy services using an ASI approach are likely to have a good long-term prognosis regarding the severity of their sensory processing functioning.

Evaluation of Ayres Sensory Integration® Intervention on Sensory Processing and Motor Function in a Child with Rubinstein-Taybi Syndrome: A Case Report.

The Rubinstein-Taybi Syndrome (RSTS) literature is limited about sensory integration, which is a foundational neurological function of the central nervous system that may affect the development of cognitive, social, and motor skills. The aim of this case report was to investigate the effects of Ayres Sensory Integration® (ASI) intervention on processing and integrating sensations, motor functions and parental goals of 3-year-old child with RSTS. Analysis of assessment data reviewed before and after treatment. Assessment collected by interview, Sensory Profile (SP), Sensory Processing Measure-Preschool (SPM-P) Home, Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measurement-88 (GMFM-88), and Gross Motor Function Classification System (GMFCS). Progress toward goals and objectives was measured with Goal Attainment Scale (GAS). ASI intervention was implemented 3 times per week for 8 weeks. At pre-intervention, SP and SPM-P Home revealed prominent sensory processing and integration difficulties in this case. PDMS-2 scores indicated the child was far behind his peers in fine and gross motor areas. In addition, systematic observations determined that the child's GMFCS level was III. After 8 weeks of ASI intervention significant improvements were found in parent reports of sensory processing in the areas of vestibular, tactile, and oral functioning on the Sensory Profile. Gains in functional motor skills were found on the GMFM-88 and the GMFCS. Consistent with these results, significant gains at or above expected levels of performance were found on GAS goals which reflected the family's main concerns for social participation, feeding, play, and movement. There are limited studies on sensory processing and integration in children with RSTS. This case report identified sensory processing and integration difficulties for the first time in a child with RSTS. Results also provide preliminary support for the positive effects of ASI intervention on sensory processing, functional motor skills, and parental goals of a child with RSTS.

Relationship Between Childhood Sensory Processing Differences and Quality of Life as Adults.

Research suggests a relationship between sensory processing, motor skills and quality of life (QOL) in a variety of clinical populations of adults and children. There have been no studies which investigated the relationship of childhood sensory processing and integration and related motor performance (sensori-motor) patterns identified using an Ayres Sensory Integration® (ASI) frame of reference and later QOL of those children as adults. This longitudinal follow-up study examined this relationship. Adult QOL was also examined in relation to current adult sensori-motor patterns. Fifty-three adults who received occupational therapy services as children, were identified as having sensori-motor difficulties at that time and completed a sensory history and a quality-of-life measure as adults participated. Measures included the OTA the Koomar Center Sensory History (SXHX), Adult/Adolescent Sensory History (ASH), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF). MANCOVA found that Total childhood sensori-motor scores had a small relationship to Physical Health QOL as adults that approached significance. Pearson Correlations found that adults with childhood sensori-motor challenges who report sensori-motor challenges as adults had a moderate significant relationship among overall sensori-motor functioning and Physical Health (r = -0.56, p = 0.018). Visual (r = -0.76, p = 0.001), movement (vestibular; r = -0.48, p = 0.042) and tactile processing (r = -0.63, p = 0.008) had moderate to large significant relationships with Physical Health. Visual processing (r = -0.54, p = 0.024) was also significantly related to Psychological Health. Motor Coordination trended to significance for Physical Health (r = -0.42) and Psychological Health (r = -0.41). Conversely, adults who reported typical sensori-motor scores as adults, despite childhood sensori-motor challenges, had a good QOL. Furthermore, similar to previous research, there was a relationship between current visual, movement (vestibular) and tactile (touch) sensory processing and adult Physical and Psychological Health. A multivariate linear regression found Sensory Discrimination and Modulation accounted for one-quarter of the variance in QOL in adults with only Discrimination being statistically significant. Therefore, it is important to consider childhood sensori-motor function as well as adult functioning when examining QOL. Further, heretofore unexamined Sensory Discrimination was found to play a role in adult QOL.

Reduced Gain and Shortened Time Constant of Vestibular Velocity Storage as a Source of Balance and Movement Sensitivities in Gravitational Insecurity.

Gravitational insecurity (GrI) involves lifetime movement and balance concerns whose pathophysiological origins are unclear. We tested whether balance symptoms in mild GrI might involve anomalies in vestibular velocity storage (VVS), a brainstem/cerebellar circuit that amplifies gain and prolongs the persistence of weak vestibular signals from small/slow head movements. A Provisional Gravitational Insecurity Index (PGrI) was developed, evaluated for psychometrics/demographics, and used to identify otherwise healthy adults with life-long balance challenges as well as sex, age, and ethnicity-matched comparison adults without such challenges. Balance confidence, sensory hypersensitivities, spatial orientation, anxiety, and hearing loss were self-reported. Standing balance under visual/proprioceptive restrictions and perrotary vestibulo-ocular nystagmus were evaluated. The PGrI showed approximated test-retest reliability and convergent and discriminant validity. When only vestibular input was available, mild GrI participants on a tilting platform used effortful hip strategies for balance significantly more than did comparison participants. Rotation testing revealed that mild GrI participants had significantly less low frequency gain and shortened VVS persistence. Combined, these two parameters correlated significantly with PGrI. The PGrI also correlated with problematic spatial orientation, but surprisingly, not to anxiety. Balance/movement issues in GrI are likely due to VVS deficiencies. Additional mechanisms may account for other GrI symptoms. Better understanding of GrI's pathophysiological basis will be useful in informing the larger health-provider community about this condition.

Influence of Ideational Praxis on the Development of Play and Adaptive Behavior of Children with Autism Spectrum Disorder: A Comparative Analysis.

BACKGROUND: Traditionally, assessment of praxis skills in children with ASD has focused on the evaluation of aspects related to the planning and execution of actions. This study aimed to evaluate the ideational abilities of children with ASD and analyze possible relationships with the development of play and adaptive behaviors. METHODS: 40 children between 4 to 6 years (TD = 20; ASD = 20) were evaluated with the Test of Ideational Praxis, the Revised Knox Preschool Play Scale, and the Adaptive Behavior Assessment System II. RESULTS: Statistically significant relationships were obtained between ideational praxis and play skills development (r = 0.649; p = 0.01), adaptive leisure behavior (r = 0.338; p = 0.04) and social adaptive behavior (r = 0.319; p = 0.04). Results of multiple linear regression models found a linear relationship between ideational praxis and play development (p = 0.005) and adaptive leisure skills (p = 0.004), but not with social interaction skills (p > 0.05). CONCLUSIONS: Objective evaluation with a specific ideational praxis assessment facilitates understanding of the ideational abilities and widens understanding of praxis skills and their impact on play and adaptive behaviors in children with ASD.

Inter-Rater and Test-Retest Reliability of the Sensory Integration Clinical Observations.

AIMS: The purpose of this study was to examine the inter-rater and test-retest reliability of the Sensory Integration Clinical Observations. METHODS: Clinical observations were administered by trained occupational therapists (recent graduates to 40 years of experience, median = 3 years) to 20 children aged 4 - 12 years. Testing was completed again on 16 children after an average of 2.5 weeks. Inter-rater therapists scored the measure from video recordings. Total score and section scores (i.e. Postural-Ocular, Motor Planning - Fine Motor, Vestibular Processing, and Praxis and Coordination) were obtained. RESULTS: Intraclass correlations found test-retest reliability of total score to be excellent (ICC=.95) and section scores to be acceptable (ICC = .79-.94). Inter-rater reliability was also excellent for total score (ICC-.94) and section scores (ICC=.84-.96). CONCLUSIONS: The Sensory Integration Clinical Observations can be administered reliably by multiple raters of varying levels of experience and results are stable over an average two-week interval. Good inter-rater reliability serves as a first step toward demonstration of consistency of administration and scoring of the Sensory Integration Clinical Observations. These findings may begin to establish a foundation for use of clinical observations to measure change in sensory-motor performance over time, although further research is needed.

Safe Place: Clinical Utility and Feasibility of a Multi-Disciplinary Intervention for Children with Sensory Processing Disorder and Complex Trauma - a Feasibility Study.

Issues of feasibility, acceptability, satisfaction, safety, and fidelity were examined in a single case program review as an initial step to assessment of the clinical utility of the SAFE PLACE program, a unique multi-disciplinary intervention program for children with complex trauma and sensory processing disorder. The feasibility of conducting a pilot intervention study was also examined. A mixed methods, single-case, program review was conducted. The intervention was the 12-week SAFE PLACE program with pre and post-intervention baseline periods. Random intervention sessions were assessed for fidelity. Post-program interviews and questionnaires were utilized to obtain qualitative and quantitative information on feasibility, acceptability, satisfaction, and safety. The SAFE PLACE fidelity measure demonstrated the intervention was safe and implemented with fidelity to the intervention model. The intervention was acceptable to the family with an average rating of 4.3 (between acceptable and perfectly acceptable) on a five-point scale. The family was very satisfied with the intervention and its outcomes with a rating of 4.75 (between satisfied and very satisfied). Numerous positive qualitative comments about participation in the program and outcomes of the intervention were spontaneously provided by the family. Staff satisfaction rating was 4.3. Scheduling, staffing and financial reimbursement feasibility challenges were identified. Preliminary outcomes of the intervention suggested positive results and provided guidance for selection of future clinical and research outcome measures. The SAFE PLACE intervention was found to be a safe, acceptable intervention with high caregiver satisfaction that could be delivered with fidelity. The program was deemed feasible for future research studies but scheduling, staffing and financial reimbursement challenges may inhibit implementation in routine clinical practice.

Characteristics and Prevalence of Gravitational Insecurity in Children with Sensory Processing Dysfunction.

BACKGROUND: Children with sensory processing challenges often demonstrate a specific vestibular dysfunction characterized by an irrational fear of movement experiences referred to as gravitational insecurity. PROCEDURES/OUTCOMES: This descriptive, exploratory study of existing de-identified data examined characteristics and prevalence of symptoms indicative of gravitational insecurity and the relationship among gravitational insecurity, gender, age, and other types of sensory-motor problems in 689 children, aged 4-12 years, with Sensory Processing Disorder (SPD) and related parent-reported co-morbid diagnoses of Attention Deficit-Hyperactivity Disorder, Anxiety Disorder, Learning Disabilities and Autism Spectrum Disorder. Gravitational insecurity was identified by the sum of eight items on a parent-report clinical questionnaire of sensory processing and motor skills in children. RESULTS/CONCLUSIONS: The number and patterns of gravitational insecurity symptoms were not significantly different across age, gender or comorbid diagnoses. Prevalence of symptoms of gravitational insecurity in a clinical population of children with SPD was 15 - 21%. Cluster analysis found two groups with and without gravitational insecurity. In the gravitational insecurity group all eight items examined occurred "sometimes/often" and four or more symptoms were reported by individuals in this group. IMPLICATIONS: Gravitational insecurity is an important vestibular-based dysfunction to identify and treat in children with SPD. Future studies should examine the relationship between these symptoms and objective measures of gravitational insecurity.

Neural Foundations of Ayres Sensory Integration®.

Sensory integration, now trademarked as Ayres Sensory Integration® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The theory and practice of ASI continues to evolve as greater understanding of the neurobiology of human behavior emerges. In this paper we examine core constructs of ASI identified in the seminal work of Dr. Jean Ayres, and present current neuroscience research that underlies the main patterns of sensory integration function and dysfunction. We consider how current research verifies and clarifies Ayres' propositions by describing functions of the vestibular, proprioceptive, and tactile sensory systems, and exploring their relationships to ocular, postural, bilateral integration, praxis, and sensory modulation. We close by proposing neuroplasticity as the mechanisms underlying change as a result of ASI intervention.

State of the Science of Sensory Integration Research With Children and Youth.

Many children and youth with and without disabilities are affected by challenges in processing and integrating sensations. Occupational therapy practitioners serve a pivotal role in the evaluation and treatment of this population. This special section of the American Journal of Occupational Therapy includes articles that elucidate the relationship between sensory processing and participation in valued occupations as well as articles that guide best practice, including systematic reviews on common occupational therapy interventions for children and youth with challenges in processing and integrating sensation. This editorial elaborates on key issues for future research.

Efficacy of Occupational Therapy Using Ayres Sensory Integration®: A Systematic Review.

This systematic review addresses the question "What is the efficacy of occupational therapy using Ayres Sensory Integration® (ASI) to support functioning and participation as defined by the International Classification of Functioning, Disability and Health for persons with challenges in processing and integrating sensory information that interfere with everyday life participation?" Three randomized controlled trials, 1 retroactive analysis, and 1 single-subject ABA design published from 2007 to 2015, all of which happened to study children with autism, met inclusion criteria. The evidence is strong that ASI intervention demonstrates positive outcomes for improving individually generated goals of functioning and participation as measured by Goal Attainment Scaling for children with autism. Moderate evidence supported improvements in impairment-level outcomes of improvement in autistic behaviors and skills-based outcomes of reduction in caregiver assistance with self-care activities. Child outcomes in play, sensory-motor, and language skills and reduced caregiver assistance with social skills had emerging but insufficient evidence.

State of the Science: A Roadmap for Research in Sensory Integration.

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.

Interrater reliability and discriminative validity of the structural elements of the Ayres Sensory Integration Fidelity Measure.

This study examined the reliability and validity of the structural section of the Ayres Sensory Integration® Fidelity Measure© (ASIFM), which provides a method for monitoring the extent to which an intervention was implemented as conceptualized in studies of occupational therapy using sensory integration intervention methods (OT-SI). We examined the structural elements of the measure, including content of assessment reports, availability of specific equipment and adequate space, safety monitoring, and integration of communication with parents and other team members, such as collaborative goal setting with parents or family and teacher education, into the intervention program. Analysis of self-report ratings by 259 occupational therapists from 185 different facilities indicated that the structural section of the ASIFM has acceptable interrater reliability (r ≥ .82) and significantly differentiates between settings in which therapists reportedly do and do not practice OT-SI (p < .001).

Interrater Reliability and Developmental Norms in Preschoolers for the Motor Planning Maze Assessment (MPMA).

This study established interrater reliability and preliminary developmental score guidelines for preschool children (ages 3-5 yr) on the Motor Planning Maze Assessment (MPMA). We administered the MPMA to 80 typically developing preschoolers and found age effects for Time, Error, and Total scores for each of three mazes. Five-year-olds obtained lower (better) scores than 4-yr-olds, who scored lower than 3-yr-olds. Older children completed the mazes with significantly fewer errors in significantly less time than younger children. Interrater reliability was excellent on the total MPMA score (intraclass correlation coefficient = 0.96) and individual maze scores (0.90-0.98). Results of this study provide evidence that the MPMA can serve as a reliable, objective screening of a preschooler's ability to plan and execute motor movements. A larger reference population is needed to increase generalizability.

Test of Ideational Praxis (TIP): Preliminary Findings and Interrater and Test-Retest Reliability With Preschoolers.

Praxis is the ability of the brain to develop an idea for action and plan, organize, and execute unfamiliar motor actions. It enables purposeful interaction with people and things in the environment. Ideation is central to praxis but has been little researched. This study investigated the reliability of the Test of Ideational Praxis (TIP) and examined ideational praxis in typical preschoolers. TIP performance for 78 preschoolers ages 3, 4, and 5 yr was videotaped and scored by two trained raters. The TIP has strong interrater reliability, supporting earlier findings. Further, we documented test-retest stability over 2 wk. As a group, preschoolers identified 10.6 affordances (ideas) for action on the TIP; no age differences were found. Training is required for accurate scoring of the TIP; following training, clinicians and researchers may find the TIP a useful tool to screen motor ideational abilities in young children.

State of measurement in occupational therapy using sensory integration.

This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome measurement. The need for additional measurement tools in all three areas is addressed. In regard to outcome measurement of occupational therapy using sensory integration, the use of both qualitative and quantitative methods to obtain outcome data is recommended. Further, a strategy is recommended for obtaining outcome data from direct report from the child or other stakeholder.

Birth and developmental correlates of birth weight in a sample of children with potential sensory processing disorder.

BACKGROUND: Most research examining birth history (i.e. related birth complications) and developmental milestone achievement follow outcomes for infants at-risk with very specific birth weight categories and gestational age classifications. The purpose of this study was to examine how birth weight relates to infants' birth histories and developmental milestone achievement when they fall into a variety of birth weight and gestational age categories. METHODS: In the current study, we examined birth histories and onset ages for developmental milestones by analyzing a convenience sample of anonymous existing data from 663 developmental histories completed by parents at the time of an initial evaluation at a pediatric outpatient occupational therapy clinic. Infants fell into 3 birth weight categories; low birth weight (LBW), normal birth weight (NBW), and high birth weight (HBW) and 3 gestational age classifications considered with birth weight; small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). RESULTS: NBW, AGA, and SGA infants with related birth complications had lower birth weights than infants without birth complications. Larger birth weights were associated with earlier ages for independent sitting for HBW infants, earlier ages for eating solids for NBW infants, and earlier walking onsets for LBW and NBW infants. Higher birth weights were also linked with rolling at a younger age for LGA infants, earlier walking and speaking words for AGA infants, and sooner independent sitting for SGA and AGA infants. CONCLUSIONS: Our findings suggest that birth weight and gestational age categories provide unique insights into infants' birth history and developmental milestone achievement.