Visual-Motor Integration Associated with Familial Liability for Autism

Background:   School-age children with Autism Spectrum Disorder (ASD) exhibit particular difficulty with tasks that rely heavily on hand-eye coordination. In addition, these children show what appears to be an ASD-specific bias against using visual feedback during motor learning that is a robust predictor of their motor and social impairments (Haswell et al., 2009). Compelling evidence also suggests motor deficits are observable as early as 6 months of age in children who later develop ASD (Flanagan, Landa, Bhat, & Bauman, 2012). However, the interplay of early motor, visual and social skill development in ASD is not well understood. Because integration of visual input with motor output is vital for the formation of internal models of action necessary not only to develop a wide range of motor skills, but also to imitate and interpret the actions of others, closer examination of motor, and specifically visual-motor, deficits is of critical importance in understanding the pathophysiology of ASD.

Objectives:   The goal of this study was to examine for behavioral markers of motor development, with a focus on visual-motor integration, in infants identified as at high risk for ASD (e.g., infants who have at least one sibling with an ASD diagnosis) using the ball-catching component of the Autism Observation Scale for Infants (AOSI; Bryson, Zwaigenbaum, McDermott, Rombough, & Brian, 2007). We hypothesized that infants at high risk for ASD would be delayed in developing a visually guided, open-handed reach strategy of catching.

Methods: Thirty-six 6-month-olds were tested (18 high-risk for ASD because they had an older sibling with ASD; 18 low risk, having no family history of ASD). The AOSI was video-recorded and the ball-catching component was scored offline by two trained raters, blind to risk group. The coding schema characterized the maturity of five behaviors during ball-catching: 1) anticipation of the examiner’s action of rolling the ball toward the child; 2) visual tracking of the ball during the roll; 3) anticipatory grasping behavior during the roll; 4) maturity of lifting the ball after contact; and 5) visual-motor integration during object exploration. The first three rolls of the ball-catching task for each child were scored, and scores were averaged across trials.

Results:   An independent samples Mann-Whitney U test indicated that the distributions of anticipation scores were different across groups, with high-risk infants showing less anticipatory grasping compared to low-risk infants (p = .022).  High-risk infants also displayed less mature lifting (p = .024).  No other significant group differences were observed, with the majority of children in both groups immediately looking at the ball or the examiner prior to the roll, tracking the ball for most of its trajectory, and simultaneously exploring the ball with their eyes and hands.

Conclusions:   Results suggest that early motor delays are more common in high-risk infants compared to low-risk infants and that high-risk infants less rapidly interpret the action intentions of others.  Findings preliminarily support our hypothesis that high-risk infants do not use visual information to guide their movements as effectively as their low-risk age peers.