JMIR Publications

ABSTRACT

Background:

Children with Autism Spectrum Disorder (ASD) exhibit poor imitation, movement planning, and praxis skills that in turn compound their core social communication and behavioral difficulties (Srinivasan et al., 2018, 2015).

Objective:

Our randomized controlled trial compares the effects of two whole-body movement interventions [creative movement (“Play”) and general exercise (“Move”)] to a seated play standard-of-care intervention (“Create”) on imitation and praxis skills in children with ASD. As part of this clinical trial, we also compare face-to-face (F2F) versus telehealth (TH) modes of intervention delivery in each of the 3 groups.

Methods:

44 children with ASD between 5 and 14 years participated in this 10-week study. Children were matched at baseline and assigned to either the Play, Move, or Create groups; (N=14-15/group). Approximately half of the children in each group were seen F2F versus the other half were seen via TH. Training was provided 2 times/week, 60-90 minutes/session for 8 weeks. We administered the Bilateral Motor Coordination (BMC) and Postural Praxis (PP) subtests of the Sensory Integration and Praxis Test (SIPT) (Ayres, 1989) at pretest and posttest, and assessed spatial and temporal errors in movement execution during both tests. We calculated the % total imitation error score for both subtests.

Results:

For the SIPT-PP, we found a reduction in percent total errors from pretest to posttest in the play [Mean(SE) - Pretest:15.8(1.1); Posttest:12.9(1.1) , p0.05], move [Mean(SE) - Pretest:17.1(1.4); Posttest:14.8(1.2), p0.05], and create groups [Mean(SE) - Pretest:16.5(1.5); Posttest:12.7(1.7) , p0.05]. There were no statistically significant differences in the percent reduction in total errors in children seen F2F versus via TH in play [Mean(SE) - F2F:3.4(1.5); TH:2.4(2.1), p=0.72], move groups [Mean(SE) - F2F:2.6(1.6); TH: 2.1(1.5), p=0.84], and create groups Mean(SE) - F2F:6.1(1.2); TH:3.4(1.8), p=0.22]. For the SIPT-BMC, children significantly reduced percent total error scores from pretest to posttest only in the play group [Mean(SE) - Pretest:8.6(2.4); Posttest:3.9(0.7) , p0.05] but not in the move and create groups. Specifically, children in the play group improved on spatial errors [Mean(SE) - Pretest:9.1(1.9); Posttest:5.4(1.2) , p0.05] and also showed a trend for improvement in temporal errors [Mean(SE) - Pretest:9.2(3.3); Posttest:3.1(0.6) , p=0.06]. Similar to the SIPT-PP, we found no significant differences in percent reduction in total errors for children seen F2F vs. via TH [Mean(SE) - F2F:2.0(1.5); TH:7.3(3.8), p=0.23].

Conclusions:

Our pilot data suggest that imitation-based gross and fine motor training activities lead to improved postural imitation skills in children with ASD across all 3 groups. However, only the play group that received rhythmic movement practice improved on the bilateral motor coordination subtest of the SIPT. Our findings suggest that improvements in imitation and praxis skills are highly training-specific in children with ASD. The lack of significant differences between F2F and TH modes across all groups suggests that TH could be a successful method of intervention delivery to promote imitation/praxis skills in children with ASD.