Gravitational Insecurity in Children With Sensory Integration and Processing Problems

RESEARCH QUESTIONS:

What is the incidence of gravitational insecurity (GI) in children with sensory processing disorder (SPD) and/or autism spectrum disorder (ASD)?

What is the relationship between GI and other types of sensory, motor, and emotional problems in children with SPD and/or ASD?

RATIONALE: GI is a fearful and anxious reaction to movements involving lifting the feet off the floor, change in head position, and movement on unstable surfaces. Ayres identified GI as one disorder among a subgroup of problems involving the vestibular system. Children who experience GI have exaggerated fear responses to movement that can affect their social relationships because society often misunderstands these responses as psychological conditions. Little is known about the incidence, distribution, and characteristics of GI in children with SPD and/or ASD.

DESIGN: Descriptive, quantitative study

PARTICIPANTS: A deidentified database of the OTA Developmental/Sensory History (SXHX) on 842 children, 4–12 yr old, was examined. Data were collected, deidentified, and databased as part of previous record review studies from clinical records at a private occupational therapy clinic. Sensory histories were completed at the time of initial evaluation. All children had no caregiver-reported neurological motor coordination problem or mental health diagnoses. All were identified with SPD as part of the initial evaluation; 22% had self-identified ASD.

MEASURE: The SXHX is an unstandardized 121-item caregiver questionnaire reporting birth history–early childhood development and sensory, motor, and social–emotional problems on a scale ranging from 1 (never) to 5 (always). Items are reported as total and section scores, including Visual/Spatial and Movement. GI items were identified on the basis of clinical experience, factors identified on the Adult/Adolescent Sensory History, and a GI questionnaire.

METHOD: Data for this proposed study were completely deidentified for secondary analysis and cannot be linked to any potential identifying information for the original record review studies.

ANALYSIS: Frequencies and score distribution determined incidence of GI problems. Pearson correlations examined relationships between GI subscore and other scores on the SXHX. Paired t tests examined differences between groups.

RESULTS: Of 842 children with SPD and/or ASD, 8.6% had mild GI and 3.7% had definite GI. A subgroup of children with ASD had 7.1% mild GI and 14.3% had definite GI. There were no significant differences in mean GI scores by comorbid diagnoses except for those with anxiety/mood disorders (p = .001), who had more severe GI. There were significant (p = .001) gender differences, with girls having more severe GI, and no significant differences by age. There were significant correlations (p < .000) between GI and motor skills (r = .278) and movement (vestibular; r = .679). No significant relationships were found between GI and social–emotional skills or visual–spatial skills.

DISCUSSION: This study identifies GI problems in >12% of children with SPD and/or ASD, with a greater percentage of children with ASD having definite GI. Anxiety disorders and being female are associated with more severe GI. Age is not a factor in GI in children and thus is not supported as a developmental problem. Proposed relationships between vestibular functioning and motor skills are supported.

IMPACT STATEMENT: GI is a disorder that has the potential to have a negative impact on the emotional development of children with SPD. This study demonstrates that a significant percentage of children with SPD and/or ASD demonstrate GI and thus this is a problem that should be addressed by occupational therapists.