Relationships Among Visual–Perceptual–Motor Skills,Sensory Processing Behaviors,and Handwriting in School-Age Children With Autism

PURPOSE: The purpose of this study was to explore the relationships between sensory processing skills and visual–perceptual–motor (VPM) skills in school-age children with autism. Children with autism tend to have difficulties in these skill areas, especially when performing school-related activities, including handwriting. An applicable study investigating this relationship has yet to be performed. More information about the relationships between VPM skills and sensory processing could help determine how challenges in these areas may affect daily functioning and school performance. Increased understanding of the relationships between these two constructs could assist in the development of intervention strategies for children with ASD and both VPM and sensory processing issues.

METHOD: This study used a correlational descriptive design. Inclusion criteria were children enrolled in Grades 1–4 who had a diagnosis of ASD, attended general education classes, and could speak and understand English. After approval by the A. T. Still University’s Arizona School of Health Sciences institutional review board, a convenience sample of 17 children (13 boys, 4 girls) was recruited from a pediatric outpatient therapy clinic in the Phoenix, Arizona, metropolitan area. The study participants, who included the children and their parent or caregiver, were scheduled for a 2-hr appointment at the pediatric outpatient clinic with two of the investigators to complete consent forms and the assessments. Three assessments were used: the Sensory Profile 2 (SP–2; Dunn, 2014); the Beery–Buktenica Developmental Test of Visual Motor Integration, sixth edition (Beery VMI–6; Beery et al., 2010); and the Test of Handwriting Skills–Revised (THS–R; Milone, 2007). One investigator worked with the child to complete the Beery VMI–6 and THS–R. The other investigator met with the child’s caregiver to complete the SP–2 using the interview method.

RESULTS: Nine sensory systems were tested on the SP–2. Of the nine, the auditory system had a significant correlation to the motor coordination subtest on the Beery VMI–6 (p < .05, two-tailed; n = 16). Spearman correlation analysis revealed two significant correlations of the SP–2 and the THS–R (p < .05, two-tailed; n = 17). The results showed a correlation coefficient of –.466 (p < .05) between the auditory sensory systems of the SP–2 and Subtest 9 (copying selected sentences) of the THS–R . The results also showed a correlation between Subtest 9 of the THS–R and the conduct sensory systems of SP–2 with a correlation coefficient of –.471 (p < .05).

CONCLUSION: Findings revealed a statistically significant relationship between auditory sensory systems and motor coordination in children with autism. Results also showed that children with autism tended to focus on the details of a writing task (writing individual letters one at a time while given no model to copy) rather than understanding words and sentences in their totality (formation of sentences and words while given a model to copy). A significant correlation was also found between the sensory system of conduct and the ability to complete a longer task, such as copying a sentence.

The study of the relationship among sensory processing, visual–motor integration, visual–perceptual skills, motor coordination, and handwriting in school-age children with ASD is important in demonstrating the broad intervention needs of these children to optimize participation in occupation. Occupations involving all of these skills include completing written assignments, dressing, eating, and playing. For school-age children, handwriting is essential to fully participate in school activities, which are often performed with time constraints. Results of the current research can be applied to address the auditory needs that contribute to conduct problems stemming from pressure to perform on handwriting tasks by informing clinicians and teachers to reduce time restraints placed on these tasks.

Modifications to classroom seating placement can ensure that a child is able to hear the teacher and be less distracted by extraneous auditory input. Students can be encouraged to ask clarifying questions to confirm complete understanding of assignment instructions. Supplying ample instruction in multiple formats, such as verbal, visual, and tactile, can enhance the child’s ability to overcome auditory sensory challenges and to fully grasp the necessary outcome of the assignment. Occupational therapy practitioners can provide adaptations to the classroom and home environment to assist the child in communicating with parents or teachers when he or she is in need of support in task completion. This additional knowledge regarding the relationships between sensory processing and VPM skills, visual–perceptual skills, motor coordination, and handwriting can support occupational therapy practitioners by suggesting different strategies to increase engagement and independence in daily functioning and school performance of school-age children with autism.

References

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Milone, M. (2007). Test of Handwriting Skills revised manual. Novato, CA: Academic Therapy Publications.