Yang, Pengjie; (2024) Visuomotor Integration and Literacy Skills in Autistic Children and Adolescents. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Autism spectrum disorder (ASD), henceforth autism, is a neurodevelopmental condition characterized by "persistent deficits in social interaction and communication across multiple contexts," as well as "restricted or repetitive patterns of behaviours, interests, or activities" (DSM-V; American Psychiatric Association, 2013). Autism is a neurodevelopmental condition with ~87% of autistic individuals showing sensorimotor differences (Roman-Urrestarazu et al., 2021). Additionally, these differences are present in several domains, such as physical activities, competence of daily living activities, and school attainment (e.g., literacy skills) in autistic children and adolescents (Miller et al., 2024). Currently, several studies have found that visuomotor integration (i.e., an ability to integrate visual information and motor function; e.g., Beery & Beery, 2014) is positively correlated to literacy skills in non-autistic children and adolescents (Becker et al., 2014; Bellocchi et al., 2017; Cameron et al., 2015), however it remains unclear whether visuomotor integration is related, or indeed, predicts literacy outcomes in autistic children and adolescents. To fill this research gap and further the understanding of sensorimotor differences and literacy skills in autistic children and adolescents, this PhD programme of work utilised both quantitative and qualitative methods across 4 studies to examine 1) sensorimotor differences in autistic compared to non-autistic populations; 2) whether visuomotor integration, as well as the markers to quantify the underlying motor mechanisms, may predict literacy outcomes in autistic children and adolescents; 3) teachers’ beliefs, knowledge and frequency of activities of sensorimotor skills in autistic children and adolescents. In study 1 (Chapter 3), a systematic review was conducted and found that over 50% of the included studies (n = 97) showed differences of 3 sensorimotor control and learning processes in the general autistic population compared to the non-autistic population, using movement outcomes (e.g., movement time and total error) and production measures (e.g., kinematic analysis markers). Few studies have investigated adaption as a function of practice. However, it was shown that blocked practice was an optimal type of practice for sensorimotor learning in autistic populations. In study 2 (Chapter 4), a cross-sectional study investigated 51 verbal autistic children aged 7 to 11 years old on whether visuomotor integration was a predictor of their literacy skills, when accounting for other measures (e.g., intelligence quotient and executive function). The results suggested that full-scale IQ was the only significant predictor of reading. Reading and age were significant predictors of handwriting fluency. Although visuomotor integration was not a significant predictor of literacy skills, it was significantly correlated with reading (r = .53) and handwriting fluency (r =.51). Study 3 (Chapter 5) investigated autistic (n = 32) and nonautistic children (n = 29) aged 7 to 11 years old in two parts. A mixed repeated measure ANOVA found that autistic children had less symbol production error, more symbol production error variability, more variability in percentage time to peak velocity than non-autistic children. Secondly, as an extension of study 2, a cross-sectional study was conducted to investigate whether markers representing the underlying sensorimotor control mechanisms [i.e., sensorimotor planning (e.g., percentage time to peak velocity) and performance (e.g., spatial production error) markers], were predictors of literacy skills in children aged 7 to 11 years old. Similar to the findings of study 2, full-scale IQ was the only significant predictor of reading. Age was a significant predictor of handwriting fluency. Although percentage time to peak velocity and symbol production error were not significant predictors of literacy skills, percentage time to peak velocity was significantly correlated with reading (r = -.26) and handwriting fluency (r =-.35); symbol 4 production error was significantly correlated with reading (r = .26). In study 4 (Chapter 6), a novel survey was conducted with 114 teaching staff to examine their beliefs, knowledge, and frequency of activities of sensorimotor skills in autistic children aged 7 to 11 years old, compared to other key skills (i.e., literacy and maths skills). It was found that teachers had placed more importance on motor skills, compared to maths skills. Teachers had more variability in knowledge of motor skills, compared to literacy and maths skills. Finally, SEN schoolteachers did more frequent motor skills related activities than mainstream schoolteachers. In Chapter 7, the findings of current studies in this PhD are discussed and appraised. Moreover, implications and limitations of this PhD programme of work are discussed.

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