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Sensory Integration and Praxis Patterns in Children With Autism

Article  in  The American journal of occupational therapy.: official publication of the American Occupational Therapy Association · January 2015
DOI: 10.5014/ajot.2015.012476 · Source: PubMed

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 Sensory Integration and Praxis Patterns in Children
With Autism

Susanne Smith Roley, Zoe Mailloux, L. Diane Parham,

Roseann C. Schaaf, Christianne Joy Lane, Sharon Cermak

MeSH TERMS OBJECTIVE. We sought to characterize sensory integration (SI) and praxis patterns of children with autism
 apraxias spectrum disorder (ASD) and discern whether these patterns relate to social participation.

 child development disorders, pervasive METHOD. We extracted Sensory Integration and Praxis Tests (SIPT) and Sensory Processing Measure
(SPM) scores from clinical records of children with ASD ages 4–11 yr (N 5 89) and used SIPT and
 imitative behavior
SPM standard scores to describe SI and praxis patterns. Correlation coefficients were generated to discern
 sensation disorders
relationships among SI and praxis scores and these scores’ associations with SPM Social Participation
 social participation scores.
RESULTS. Children with ASD showed relative strengths in visual praxis. Marked difficulties were evident in
imitation praxis, vestibular bilateral integration, somatosensory perception, and sensory reactivity. SPM So-
cial Participation scores were inversely associated with areas of deficit on SIPT measures.
CONCLUSION. Children with ASD characteristically display strengths in visuopraxis and difficulties with
somatopraxis and vestibular functions, which appear to greatly affect participation.

Roley, S. S., Mailloux, Z., Parham, L. D., Schaaf, R. C., Lane, C. J., & Cermak, S. (2015). Sensory integration and praxis
patterns in children with autism. American Journal of Occupational Therapy, 69, 6901220010. http://dx.doi.org/
10.5014/ajot.2015.012476

Susanne Smith Roley, OTD, OTR/L, FAOTA, is

Adjunct Assistant Professor of Clinical Occupational
Therapy, Mrs. T. H. Chan Division of Occupational
E stimated prevalence rates of sensory processing problems among children
with autism spectrum disorder (ASD) range from approximately 40% to
>90% (Baker, Lane, Angley, & Young, 2008; Baranek, David, Poe, Stone, &
Science and Occupational Therapy, University of Southern
California, Los Angeles; [email protected] Watson, 2006; Tomchek & Dunn, 2007). These estimates are primarily based
on data from caregiver questionnaires that measure sensory reactivity. The
Zoe Mailloux, OTD, OTR/L, FAOTA, is Adjunct
Associate Professor, Department of Occupational Therapy,
recognized, widespread presence of atypical sensory reactivity among people
Jefferson School of Health Professions, Thomas Jefferson with ASD recently led to its inclusion as a diagnostic feature of ASD in the
University, Philadelphia, PA. Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psy-
chiatric Association, 2013) under the criterion of “restricted, repetitive patterns
L. Diane Parham, PhD, OTR/L, FAOTA, is Professor,
Occupational Therapy Graduate Program, University of of behavior, interests, or activities” (p. 50).
New Mexico, Albuquerque. Atypical sensory reactivity (usually called sensory modulation or sensory re-
sponsiveness in the occupational therapy literature) has been linked to regulatory
Roseann C. Schaaf, PhD, OTR/L, FAOTA, is Professor and
functions such as arousal, attention, affect, and activity level and may result in
Chair, Department of Occupational Therapy, Jefferson School
of Health Professions, and Faculty at the Farber Institute for extreme behavioral differences that interfere with social participation (Baranek,
Neuroscience at Thomas Jefferson University, Philadelphia, PA. 2002; Ben-Sasson, Carter, & Briggs-Gowan, 2009; Ben-Sasson et al., 2007;
Liss, Saulnier, Fein, & Kinsbourne, 2006; Reynolds, Millette, & Devine, 2012;
Christianne Joy Lane, PhD, is Assistant Professor,
Division of Biostatistics, Department of Preventive
Reynolds, Thacker, & Lane, 2012). Some researchers have reported positive
Medicine, Keck School of Medicine, University of associations between hyporeactivity and social communication symptom se-
Southern California, Los Angeles. verity (Watson, Baranek, Roberts, David, & Perryman, 2010), whereas others
have found that child hyperreactivity is likely to negatively affect family life and
Sharon Cermak, EdD, OTR/L, FAOTA, is Professor, Mrs.
T. H. Chan Division of Occupational Science and Occupational social adaptive behaviors of school-age children (Ben-Sasson et al., 2009).
Therapy, University of Southern California, Los Angeles. Sensory reactivity is only one of several sensory integration (SI)-related
patterns of functioning known to affect children who have learning and

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 behavioral challenges. These patterns emerged in past social skills. Moreover, praxis abilities may be associated
factor analytic studies using the Sensory Integration and with social and communicative functions of people with
Praxis Tests (SIPT; Ayres, 1989) with diverse samples ASD (Mostofsky & Ewen, 2011). Therefore, it is reason-
of children (e.g., Ayres, 1989; Mailloux et al., 2011; able to expect that difficulties with praxis, or with the
Mulligan, 1998). Visuopraxis is a pattern that refers to the perceptual functions that support praxis, will interfere with
ability to skillfully plan actions that are heavily dependent the social participation of children with ASD.
on vision. This pattern is measured by tests of visual Although vestibular bilateral functions are seldom
perception and visual construction (Ayres, 1963, 1965, studied in children with ASD, evidence suggests that
1966a, 1966b, 1969, 1972, 1977, 1989; Mailloux et al., prolonged head lag in infancy, an early manifestation of
2011; Mulligan, 1998). Another pattern, somatopraxis, delayed postural control development, is predictive of later
reflects the ability to organize actions in relation to one’s diagnosis of ASD (Flanagan, Landa, Bhat, & Bauman,
own body. This pattern is measured by tasks requiring 2012). Limited research on groups of older children with
imitation of body positions and movement sequences and ASD (Jansiewicz et al., 2006; Minshew et al., 2004) de-
is strongly associated with measures of somatosensory scribed postural–ocular control difficulties such as ability
perception (Ayres, 1965, 1966a, 1966b, 1969, 1971, to orient, shift, and organize visual gaze; sit still and
1972, 1977, 1989). Praxis on verbal command refers to upright while working; and use tools and writing im-
planning of action while following verbal instructions plements, which requires a stable postural base of support
(Ayres, 1969, 1972, 1977, 1989; Mulligan, 1998). The (Ayres, 2005). Such difficulties with postural control may
vestibular–postural–bilateral integration and sequencing interfere with the child’s ability to participate in activities
pattern refers to smoothly coordinated head, neck, and with the same degree of efficiency and skill in movement
eye movements in concert with postural and bilateral that is evident in most children.
control (Ayres, 1965, 1966b, 1969, 1971, 1972, 1977, We designed this study to contribute to the growing
1989; Mailloux et al., 2011; Mulligan, 1998). pool of knowledge on how SI and praxis may relate to
It is plausible that, in addition to sensory reactivity, SI social participation of children with ASD. Therefore, we
patterns such as visuopraxis, somatopraxis, and vestibular– sought to answer two specific research questions: (1) What
postural–bilateral functions may also have an effect on are the characteristic SI and praxis features and patterns of
the social participation of children with autism. Although children with ASD? and (2) What are the relationships
dyspraxia is not currently recognized as a diagnostic fea- between these SI and praxis features and patterns and
ture of ASD, a growing body of evidence indicates that social participation in children with ASD?
substantial difficulties with praxis are common among
people with ASD and may even be a core feature of au-
tism (Dowell, Mahone, & Mostofsky, 2009; MacNeil & Method
Mostofsky, 2012). Motor and praxis concerns have been
Research Design
reported for children with ASD based on scores from a
variety of motor tests and movement observations (Henderson This retrospective study examined existing data on children
& Sugden, 1992; Henderson, Sugden, & Barnett, 2007; with ASD ages 4–11 yr (mean age, 7 yr) who were evaluated
Manjiviona & Prior, 1995; McDuffie et al., 2007; Minshew, as part of a comprehensive occupational therapy assessment.
Sung, Jones, & Furman, 2004; Mostofsky et al., 2006; We first reviewed records of 421 children to identify those
Rogers & Williams, 2006; Siaperas et al., 2011; Smith & with ASD, of whom we found 141. We then examined the
Bryson, 2007). records of the 141 children with ASD to identify those who
Dziuk et al. (2007) and Mostofsky et al. (2006) found had completed at least 11 of the 17 tests of the SIPT (N 5
deficits among children with ASD in ability to produce 89, 63%). Demographic data for the 141 children with ASD
meaningful and meaningless gestures on command, imitate who could take the SIPT (N 5 89) and those who could
demonstrated gestures without objects, and imitate gestures not take the SIPT (N 5 52) are summarized in Table 1 and
involving real or imaginary tool use. These praxis abilities indicate similarity between groups on age, gender distri-
require the child to interpret sensory information and then bution, ethnicity, and diagnostic categories.
formulate internal action models. Ayres and Cermak (2011) We used the SIPT test scores of these 89 children to
suggested that somatodyspraxia interferes with initiation, describe characteristic patterns of SI and praxis func-
planning, sequencing, and building repertoires of action tioning of children with ASD. Of these 89 children, 75
plans, all of which are essential in accomplishing multistep were in the age range of the SIPT normative data. The
daily routines and building a foundation for imitation and performance of 14 children ages 9–11 yr was scored using

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 Table 1. Demographics of Participants (N 5 141) With and available in the majority of records, it is reasonable to
Without Sensory Integration and Praxis Tests Scores assume that children who were able to complete the SIPT
Characteristic SIPT (N 5 89) No SIPT (N 5 52) fell in the typical range of cognitive functioning because
Age, yr (mean ± standard deviation) 7±2 7±2 performance on this test requires the child to conceptu-
Gender, n (%) ally understand and comply with standardized procedures
Male 78 (88) 41 (79)
involving novel tasks.
Female 11 (12) 11 (21)
Ethnicity, n (%) Measures
White 67 (75) 41 (79)
Hispanic 11 (13) 3 (6) The SIPT are a series of 17 tests, standardized on 1,997
Asian 10 (11) 7 (13) children ages 4 yr to 8 yr, 11 mo, designed to assess visual
African-American 1 (1) 1 (2) and tactile perception, visual–motor skills, two- and three-
Diagnosis, n (%)
dimensional construction, vestibular–proprioceptive func-
Asperger syndrome 8 (9) 3 (6)
Autism 74 (83) 46 (88)
tions, bilateral motor skills, and praxis (Ayres, 1989). Each
PDD/PDD–NOS 7 (8) 3 (6) test has high interrater reliability (r ³ .90) and discrim-
Note. PDD 5 pervasive developmental disorder; PDD–NOS 5 pervasive de-
inates between typical and atypical samples (p < .01; Ayres,
velopmental disorder–not otherwise specified; SIPT 5 Sensory Integration 1989). Content validity and construct validity have been
and Praxis Tests. established. Each test of the SIPT is administered using
visual demonstration in addition to standardized verbal in-
SIPT normative data for children age 8 yr, 11 mo, the structions with the exception of Praxis on Verbal Com-
oldest age group on which the SIPT is standardized. mand, which is solely language dependent. A lower SIPT
Records for a subset of these 89 children (N 5 48) also score indicates greater difficulty.
contained standard scores for the Sensory Processing The SPM is a questionnaire completed by parents or
Measure (SPM) Home Form (Parham & Ecker, 2007). teachers that provides standard scores based on a nor-
In the records of the 48 children with SPM Home Form mative sample of 1,051 typically developing children ages
scores, 25 also contained scores for the SPM Main 5–12 yr (Parham & Ecker, 2007). SPM scores provide
Classroom Form (Miller Kuhaneck, Henry, & Glennon, information about the child’s sensory reactivity, praxis,
2007). We used the SPM Home and Main Classroom and social participation. The Total Sensory scale score is
scores to further describe SI patterns and their relation- a composite measure of the Visual, Hearing (auditory
ship to social participation. We obtained ethical approval processing), Touch, Body Awareness (proprioception),
for this study from the institutional review board, Office and Balance and Motion (vestibular processing) scale
of Protection of Research Subjects, at the University of scores, which primarily measure sensory reactivity within
Southern California, Los Angeles. specific sensory systems. The Total Sensory score also
includes items measuring reactivity to taste and smell.
Participants The Ideas and Planning score is a measure of praxis. The
We drew the ASD sample from two private practices in Social Participation score is a measure of child partici-
Southern California. Inclusion criteria were children who pation. A higher SPM score indicates greater difficulty.
(1) received an occupational therapy evaluation from 1989 Content and construct validity has been established with
to 2011, (2) were diagnosed with ASD, (3) were between strong test–retest reliability (r > .93). Scores from the
ages 4.0 and 11.0 yr, and (4) completed at least 11 of the SPM Home Form and Main Classroom Form were an-
17 SIPT tests. For 60% of the sample the diagnosis was alyzed in this study.
provided by a psychologist, physician, neuropsychologist,
or neurologist. For 40% of the sample, the professional Data Analysis
who provided the diagnosis was not identified. The ASD Descriptive statistics were generated for the z score of each
diagnoses included Asperger syndrome, autism (including of the 17 SIPT tests and for the T score of each SPM
high-functioning autism), pervasive developmental dis- Home and Main Classroom scale. Next, the 17 SIPT
order (PDD), and PDD–not otherwise specified (PDD– scores were collapsed into six SI and praxis functions on
NOS). Attention deficit disorder was reported by 16.8% the basis of past factor and cluster analyses involving
of families of children with autism. Children with addi- normative and clinical samples (Ayres, 1989; Mailloux
tional diagnoses of seizure disorder, Fragile X syndrome, et al., 2011; Mulligan, 1998). The six functions are (1)
cerebral palsy, or mental retardation were excluded from Visual Perception (consisting of tests of motor-free visual
the study. Although measures of intelligence were not perception), (2) Visual Construction (tests of visual–motor

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 performance, including two- and three-dimensional con- Table 2. SIPT z Score Means and Standard Deviations
struction), (3) Imitation Praxis (tests requiring imitation SIPT Tests by Group N M SD
of body or orofacial position and movement), (4) Ves- Motor-Free Visual Perception Group 88 20.7 1.0
tibular Bilateral Integration and Sequencing (tests of 1. Space Visualization 88 20.7 1.0
vestibular functions, including balance and bilateral motor 2. Figure Ground Perception 87 20.6 1.2
Visual Praxis Group 89 20.8 1.0
performance), (5) Somatosensory Perception (tests of tac-
3. Design Copying 86 20.9 1.5
tile and kinesthetic perception), and (6) Praxis on Verbal 4. Constructional Praxis 88 20.6 1.1
Command (test of praxis based on unfamiliar two-step 5. Motor Accuracy 88 21.3 1.2
verbal instructions—the only SIPT test dependent on lan- Imitation Praxis 89 21.5 1.1
guage comprehension). A score for each function was created 6. Postural Praxis 88 21.4 1.4
by computing the mean of the z scores of the constituent 7. Oral Praxis 89 21.8 1.0
Vestibular Bilateral Integration and Sequencing 89 21.2 0.9
tests.
8. Postrotary Nystagmus 87 21.0 1.2
Mean SIPT z scores, SIPT SI and praxis function 9. Standing and Walking Balance 89 22.0 1.1
scores, and SPM T scores were scrutinized to determine 10. Sequencing Praxis 89 21.2 1.3
the extent to which each SI and praxis measure is char- 11. Bilateral Motor Coordination 89 0.8 1.0
acteristic of children with ASD, as indicated by distance Somatosensory: Tactile and Kinesthesia 89 1.2 1.0
12. Manual Form Perception 88 20.9 1.3
of the sample mean from the normative mean. Scores
13. Kinesthesia 83 21.3 1.3
greater than 1 standard deviation from the normative 14. Finger Identification 86 21.1 1.4
mean are considered to be clinically meaningful. On the 15. Graphesthesia 86 21.7 1.4
SIPT, z scores £–1.0 indicate areas of concern. On the 16. Localization of Tactile Stimuli 84 21.4 1.4
SPM, T scores ³60 indicate areas of concern. To de- Praxis on Verbal Command
termine the associations among SI, praxis, and social 17. Praxis on Verbal Command 89 21.4 1.5

participation measures, a correlation matrix was gener- Note. M 5 mean; SD 5 standard deviation; SIPT 5 Sensory Integration and
Praxis Tests.
ated using Pearson correlation procedures. Variables an-
alyzed in the correlation matrix were the six SI and praxis
function scores and the SPM Total Sensory, Ideas and Participation, followed by Total Sensory, Hearing, and Plan-
Planning, and Social Participation scores for both Home ning and Ideas (praxis) scales. Most of the mean scores on the
and Main Classroom forms. SPM Main Classroom were >60 (T 5 59–67), with three
borderline mean scores at 59 or 60. On the Main Classroom
form, the area of greatest difficulty was Social Participation,
Results followed by Planning and Ideas and Total Sensory scales.
Characteristic Sensory Integration and Relationships Between Social Participation and
Praxis Patterns Sensory Integration and Praxis Functions
Table 2 depicts the mean z scores of children with ASD Table 4 presents the correlations among the six SI and
on SIPT. Scores for the Visual Perception and Visual praxis functions measured by the SIPT and the three
Construction functions were the only ones within normal
limits (i.e., >–1.0). Of the SIPT tests that measure these
Table 3. SPM Home and Main Classroom Form T-Score Means
functions, the only mean z score <–1.0 was on the Motor and Standard Deviations
Accuracy test. Scores for Somatosensory Perception and
Home Form Main Classroom Form
Vestibular Bilateral Integration and Sequencing functions
SPM Scale N M SD N M SD
were z–1.2. The Praxis on Verbal Command function
Social Participation 48 70 7.2 26 67 8.0
was an area of greater impairment, with a score of –1.4,
Planning and Ideas 46 68 8.6 26 63 6.8
but the score reflecting the area of greatest difficulty was Total Sensory 46 69 7.1 26 62 7.2
Imitation Praxis (–1.5). Visual 48 67 7.9 26 59 7.8
Table 3 depicts the mean T scores of children with Hearing 48 68 8.8 26 61 10.0
ASD on the SPM Home and Main Classroom forms. Touch 48 66 9.1 26 60 9.2
Proprioception 47 67 7.5 26 60 7.9
Scores of 0–59 indicate typical function; 60–69, prob-
Balance 46 65 10.2 26 61 8.1
able dysfunction; and 70–80, definite dysfunction. The
Note. T score: 0–59, typical function; 60–69, probable dysfunction; 70–80,
mean scores on the SPM Home were all well above 60 definite dysfunction. M 5 mean; SD 5 standard deviation; SPM 5 Sensory
(T 5 65–70). The area of greatest difficulty was Social Processing Measure.

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 Table 4. Correlations Among Sensory Integration and Praxis Tests and Sensory Processing Measure Home and Main Classroom Form
Scores
Test 1 2 3 4 5 6 7 8 9 10 11 12
1. SIPT Visual Perception —
2. SIPT Visual Construction .50*** —
3. SIPT Imitation Praxis .36*** .43*** —
4. SIPT Vestibular Bilateral .36*** .61*** .51*** —
Integration and Sequencing
5. SIPT Somatosensory Perception .50*** .54*** .48*** .56*** —
6. SIPT Praxis on Verbal Command .36*** .55*** .51*** .54*** .51*** —
7. SPM–H Social Participation 2.10 2.20 2.48** 2.35* 2.25* 2.32 —
8. SPM–H Planning and Ideas 2.09 2.22 2.21 2.10 2.09 2.10 .41** —
9. SPM–H Total Sensory .10 2.04 2.10 .02 .02 -.05 .52*** .67*** —
10. SPM–C Social Participation 2.19 2.38 2.65*** 2.54** 2.44* 2.33 .40 2.11 2.09 —
11. SPM–C Planning and Ideas 2.26 2.21 2.47* 2.24 2.35 2.37 2.03 .17 .17 .48* —
12. SPM–C Total Sensory 2.07 2.08 2.56** 2.28 2.37 2.34 .11 .10 .14 .49* .68*** —
Note. SPM–C 5 Sensory Processing Measure Main Classroom Form; SPM–H 5 Sensory Processing Measure Home Form; SIPT 5 Sensory Integration and Praxis
Tests. Ns for SIPT functions 5 83–89; Ns for SPM–H 5 46–48; N for SPM–C 5 26.
*p < .05. **p < .01. ***p < .001.

SPM scales (Social Participation, Ideas and Planning, and Discussion

Total Sensory) for the Home and Main Classroom forms.
The results of this study show that children with ASD
SIPT functions that correlated most highly with Social
characteristically displayed difficulties with imitation
Participation in the home were Imitation Praxis (r 5 2.48,
praxis, vestibular bilateral functions, somatosensory per-
p < .001) and Vestibular Bilateral Integration and Se-
ception, and sensory reactivity. The areas of greatest
quencing (r 5 2.35, p < .05). Praxis on Verbal Command
strength are visual perception and visual construction. In
also had a significant correlation with Social Participation
contrast, imitation praxis is severely affected. Behaviors
at home in the low moderate range (r 5 2.32, p < .05).
indicating praxis problems and difficulty with sensory
With regard to Social Participation in the classroom, the
strongest SIPT correlations were with Imitation Praxis reactivity across multiple sensory systems are evident in the
(r 5 2.65, p < .001) and Vestibular Bilateral Integration contexts of both home and school. Social participation at
and Sequencing (r 5 2.54, p < .01). Somatosensory school in particular is strongly associated with imitation
Perception also correlated significantly with Social Par- praxis and vestibular bilateral functions. Similarly, social
ticipation at school (r 5 2.44, p < .05). participation at home is primarily associated with imitation
As expected, Imitation Praxis showed significant praxis and, to a lesser degree, vestibular bilateral functions.
correlations with SPM Main Classroom Planning and Prior research has shown that SIPT Visual Perception
Ideas (r 5 2.47, p < .05) and Total Sensory (r 5 2.56, and Visual Construction scores tend to be highly correlated
p < .01) scores. However, it was surprising that Imitation and often load together on a factor that Ayres (1989) termed
Praxis did not significantly correlate with these areas on visuopraxis. Likewise, Somatosensory Perception, Imitation
the SPM Home. The mean scores for Visual Perception Praxis, Praxis on Verbal Command, and Vestibular Bilateral
and Visual Construction did not correlate significantly Integration and Sequencing scores tend to be highly corre-
with scores on either of the SPM forms. lated and load together on a factor that Ayres (1989) termed
The SI and praxis functions on the SIPT were sig- somatopraxis. Our study shows that children with ASD have
nificantly correlated with each other (r 5 .36 to .61, p < strengths in visuopraxis and major deficits in somatopraxis.
.01). The SPM Home scores for Social Participation, To date, much research has shown that sensory re-
Planning and Ideas, and Total Sensory scales correlated activity is a major issue in children with ASD. In contrast,
with each other (r 5 .41 to .67, p < .001), as did the same very little research has examined somatopraxis of these
scales on the SPM Main Classroom (r 5 .47 to .68, p < children. Results of the current study indicate that
.001). The correlation between the Social Participation somatopraxis may be an area of difficulty that is as
scales of the SPM Home and Main Classroom forms was prevalent as sensory reactivity problems for this pop-
moderate (r 5 .40) but not statistically significant. The re- ulation. Moreover, findings of this study suggest that social
maining intercorrelations among the SPM Home and Main participation is more strongly associated with somato-
Classroom scores were close to zero (r 5 .03 to .17). praxis than with sensory reactivity.

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 The lowest mean SIPT score was on the Standing and Additional standardized performance assessments are
Walking Balance test, reflecting vestibular-related diffi- needed to measure SI and praxis in people with more severe
culties with postural control. Vestibular-related functions expressions of ASD and in older and younger age groups
are important considerations during the evaluation and than we studied here so that future research can examine
intervention of children with ASD. whether SI and praxis are associated with social partici-
Because of the language processing requirement for pation in these groups. Larger sample sizes of people with
the Praxis on Verbal Command test, we expected children ASD who also have SPM and SIPT data are needed to
with ASD to have difficulty with this test. Because of the conduct factor analyses to further clarify patterns of SI and
importance of language during social interactions, a sur- praxis deficits in autism. Studies investigating the subjective
prising finding was that Praxis on Verbal Command experiences of people with ASD and their caregivers would
showed lower correlations with Social Participation than be useful to better understand the effects of various types of
Imitation Praxis. SI and praxis deficits on social participation. Future studies
The lack of significant correlations between the SPM may provide increased understanding of the nature of SI
Home and Main Classroom forms is consistent with and praxis and their impact on engagement in occupations
findings reported in the SPM Home Form (Parham & as a means toward health, well-being, and participation.
Ecker, 2007) and may be explained by the discrepancy
between adult expectations and daily routines at home
versus at school. The degree of adult support and varying Implications for Occupational
contextual demands are important considerations with Therapy Practice
people with ASD. The results of this study have the following implications
In summary, comprehensive evaluations of sensory for occupational therapy practice:
reactivity, sensory perception, and praxis allow occupa- • A thorough SI assessment must address perception and
tional therapy practitioners to understand critical abilities praxis in addition to sensory reactivity to fully inform
linked to adaptation and social skills in ASD. Children practice and provide a deeper understanding of the SI
with ASD show relative strengths in visual praxis and factors that affect social participation of children with
deficits in somatopraxis; vestibular-related functions, in- ASD.
cluding balance; and sensory reactivity. Standardized • Assessment tools commonly used by occupational
measures of SI and praxis functions allow practitioners to therapists to evaluate children with ASD, such as mo-
ascertain difficulties that are often not overtly apparent tor skill tests and sensory history questionnaires, may
but have a great impact on the way in which people with not adequately capture critical information related to
ASD choose to engage with people and objects in their SI and praxis; thus, issues that strongly influence child
environment. participation may be left untreated.
• Identification of SI and praxis deficits in children with
Limitations and Future Research ASD can inform the use of safe and effective interven-
tion strategies that have the potential to expand child-
This study is based on an analysis of existing data in
ren’s social participation. s
clinical records. Although most of the children were di-
agnosed by medical professionals, independent assess-
ments to verify the diagnosis of ASD and measures of Acknowledgments
cognitive abilities were not available. The SPM Home and This project is in partial fulfillment of the first author’s
Main Classroom forms were available only for a subset of doctorate from the Division of Occupational Science and
children with ASD who had completed the SIPT, resulting Occupational Therapy, University of Southern Cal-
in smaller samples of children with data from these ifornia, Los Angeles. We extend our appreciation to the
questionnaires. Another limitation was the inclusion of 14 children and families who participated in this study.
children ages 9–11 yr, whose performance was scored
using SIPT normative data for children ages 8 yr, 11 mo, References
the oldest age group on which the SIPT is standardized.
American Psychiatric Association. (2013). Diagnostic and sta-
For these older children, the use of normative data from
tistical manual of mental disorders (5th ed.). Arlington, VA:
younger children may have led us to underestimate the American Psychiatric Publishing.
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