James C. Galloway

Current Perspectives on Motor Functioning in Infants, Children, and Adults With Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are the most common pediatric diagnoses in the United States. In this perspective article, we propose that a diverse set of motor impairments are present in children and adults with ASDs. Specifically, we will discuss evidence related to gross motor, fine motor, postural control, and imitation/praxis impairments. Moreover, we propose that early motor delays within the first 2 years of life may contribute to the social impairments of children with ASDs; therefore, it is important to address motor impairments through timely assessments and effective interventions. Lastly, we acknowledge the limitations of the evidence currently available and suggest clinical implications for motor assessment and interventions in children with ASDs. In terms of assessment, we believe that comprehensive motor evaluations are warranted for children with ASDs and infants at risk for ASDs. In terms of interventions, there is an urgent need to develop novel embodied interventions grounded in movement and motor learning principles for children with autism.

Relation between early motor delay and later communication delay in infants at risk for autism.

BACKGROUND Motor delays have been reported in retrospective studies of young infants who later develop Autism Spectrum Disorders (ASDs). OBJECTIVE In this study, we prospectively compared the gross motor development of a cohort at risk for ASDs; infant siblings of children with ASDs (AU sibs) to low risk typically developing (LR) infants. METHODS 24 AU sibs and 24 LR infants were observed at 3 and 6 months using a standardized motor measure, the Alberta Infant Motor Scale (AIMS). In addition, as part of a larger study, the AU sibs also received a follow-up assessment to determine motor and communication performance at 18 months using the Mullen Scales of Early Learning. RESULTS Significantly more AU sibs showed motor delays at 3 and 6 months than LR infants. The majority of the AU sibs showed both early motor delays and later communication delays. LIMITATIONS Small sample size and limited follow-up. CONCLUSIONS Early motor delays are more common in AU sibs than LR infants. Communication delays later emerged in 67-73% of the AU sibs who had presented with early motor delays. Overall, early motor delays may be predictive of future communication delays in children at risk for autism.

Movement Training Advances the Emergence of Reaching in Infants Born at Less Than 33 Weeks of Gestational Age: A Randomized Clinical Trial

Background and Purpose: This study had 2 purposes: (1) to compare the emergence of reaching in infants born full-term and infants born at less than 33 weeks of gestational age and (2) to evaluate the effectiveness of a movement training program on the emergence of reaching in this preterm population. Participants: Twenty-six infants born at less than 33 weeks of gestational age and with a birth weight less than 2,500 g were randomly assigned to receive 20 minutes of daily movement training (PT-M group) or daily social training (PT-S group) and were compared with 13 infants born full-term (FT-S group). Methods: Reaching and hand-object interactions were tested every other week for 8 weeks. At each visit, infants were allowed six 30-second opportunities to contact a midline toy. Results: The FT-S and PT-M groups reached earlier and more consistently than the PT-S group. Specifically, the subjects in the FT-S group contacted the toy for longer durations and with an open, ventral surface of their hand. The PT-M group demonstrated increases in the number of hand-object contacts, the number of consistent reaches, and the percentage of time interacting with the toy and the surface of hand-object contact. Discussion and Conclusion: This project demonstrates that there are early gross motor skill differences in infants born at less than 33 weeks of gestational age. A caregiver-based daily training program, however, is effective at lessening some, but not all, of these differences over the short term.

Power mobility training for a 7-month-old infant with spina bifida

Purpose: Power mobility is a critical assistive technology for many children with special needs. Our previous work suggests that certain infants younger than the age 1 year of age can participate in formal power mobility training. Key Points: This case report describes the feasibility of providing a power mobility training program with a young infant with spina bifida. Specifically, we longitudinally quantified the infant’s driving ability with a joystick-controlled device (UD1), using UD1’s onboard computer and video camera from an infant’s age of 7 to 12 months. During the training period, the infant improved in all driving variables. The infant’s Bayley III cognition and language scores also increased at a rate greater than his chronological age. Conclusions/Implications for Clinical Practice: These results suggest that power mobility training within the first year of life may be appropriate for certain populations at risk of immobility.

Social and Non-social Visual Attention Patterns and Associative Learning in Infants at risk for Autism

BACKGROUND Social inattention is common in children with autism whereas associative learning capabilities are considered a relative strength. Identifying early precursors of impairment associated with autism could lead to earlier identification of this disorder. The present study compared social and non-social visual attention patterns as well as associative learning in infant siblings of children with autism (AU sibs) and low-risk (LR) infants at 6 months of age. METHODS Twenty-five AU sibs and 25 LR infants were observed in a novel social-object learning task, within which attention to social and non-social cues was contrasted. Video recorded data were coded for percent duration of gaze to objects or caregiver. Movement rates to activate the toy within the associative learning task were also quantified. RESULTS Both groups learned the association between moving a switch and activating a cause-effect toy. AU sibs spent less time looking at caregivers and more time looking at the toy or joystick when their caregivers made no attempts to engage their attention. However, response to caregiver-initiated social bids was comparable for both groups. CONCLUSIONS Infrequent self-initiated socially directed gaze may be an early marker of later social and communication delays.

Power Mobility and Socialization in Preschool: Follow-up Case Study of a Child With Cerebral Palsy

PURPOSE Our previous study found it feasible for a preschooler with cerebral palsy (CP) to use a power mobility device in his classroom but noted a lack of typical socialization. The purpose of this follow-up study was to determine the feasibility of providing mobility and socialization training for this child. METHODS Will, a 3-year-old with CP, 1 comparison peer, 2 preschool teachers, and 2 therapists were filmed daily during a training and posttraining phase. Adult-directed training was provided in the classroom by therapists and teachers during the training phase. Mobility and socialization measures were coded from video. OUTCOMES During training, Will demonstrated greater socialization but less mobility than the comparison peer. Posttraining, Will socialized less but was more mobile, though less mobile than the comparison peer. DISCUSSION Short-term, adult-directed power mobility and socialization training appear feasible for the preschool classroom. Important issues regarding socialization and power mobility are discussed.

Assessment and stability of early learning abilities in preterm and full-term infants across the first two years of life.

Infants born preterm have increased risk for learning disabilities yet we lack assessments to successfully detect these disabilities in early life. We followed 23 full-term and 29 preterm infants from birth through 24 months to assess for differences in and stability of learning abilities across time. Measures included the Bayley-III cognitive subscale, the mobile paradigm assessment, and a means-end learning assessment. Preterm infants had poorer performance on measures of cognition and learning across the first two years of life. Learning performance at 3-4 months was consistent with learning performance at 12-24 months of age. At 3-4 months, the mobile paradigm had better sensitivity and predictive values for predicting 24-month cognitive delays on the Bayley-III than did the Bayley-III itself. At 12-18 months, the means-end learning assessment had better sensitivity than the Bayley-III for identifying 24-month cognitive delays on the Bayley-III. The results suggest that: (1) infants born preterm may demonstrate learning differences as early as the first few months of life, (2) learning differences identified in the first months of life are likely to persist throughout the second year of life, and (3) learning assessments that measure how infants and toddlers use their typical behaviors to problem-solve to control external events may be more effective than traditional standardized assessment tools for detecting early learning delays.

The onset of reaching significantly impacts how infants explore both objects and their bodies.

The purpose of this study was to describe how reaching onset affects the way infants explore objects and their own bodies. We followed typically developing infants longitudinally from 2 through 5 months of age. At each visit we coded the behaviors infants performed with their hand when an object was attached to it versus when the hand was bare. We found increases in the performance of most exploratory behaviors after the emergence of reaching. These increases occurred both with objects and with bare hands. However, when interacting with objects, infants performed the same behaviors they performed on their bare hands but they performed them more often and in unique combinations. The results support the tenets that: (1) the development of object exploration begins in the first months of life as infants learn to selectively perform exploratory behaviors on their bodies and objects, (2) the onset of reaching is accompanied by significant increases in exploration of both objects and ones own body, (3) infants adapt their self-exploratory behaviors by amplifying their performance and combining them in unique ways to interact with objects.

Enhanced Handling and Positioning in Early Infancy Advances Development Throughout the First Year

Behaviors emerge, in part, from the interplay of infant abilities and caregiver-infant interactions. Cross-cultural and developmental studies suggest caregiver handling and positioning influence infant development. In this prospective, longitudinal study, the effects of 3 weeks of enhanced handling and positioning experiences provided to 14 infants versus control experiences provided to 14 infants at 2 months of age were assessed with follow-up through 15 months of age. Behaviors in prone were immediately advanced. Short-term advancements occurred in multiple behaviors, including prone, head control, reaching, and sitting behaviors. Longer term advancements, up to 12 months after the experience period, occurred in object transfer, crawling and walking behaviors. This suggests broad and long-lasting changes can arise via brief periods of change in caregiver-infant interactions.

Training Toddlers Seated on Mobile Robots to Drive Indoors Amidst Obstacles

Mobility is a causal factor in development. Children with mobility impairments may rely upon power mobility for independence and thus require advanced driving skills to function independently. Our previous studies show that while infants can learn to drive directly to a goal using conventional joysticks in several months of training, they are unable in this timeframe to acquire the advanced skill to avoid obstacles while driving. Without adequate driving training, children are unable to explore the environment safely, the consequences of which may in turn increase their risk for developmental delay. The goal of this research therefore is to train children seated on mobile robots to purposefully and safely drive indoors. In this paper, we present results where ten typically-developing toddlers are trained to drive a robot within an obstacle course. We also report a case study with a toddler with spina-bifida who cannot independently walk. Using algorithms based on artificial potential fields to avoid obstacles, we create force field on the joystick that trains the children to navigate while avoiding obstacles. In this “assist-as-needed” approach, if the child steers the joystick outside a force tunnel centered on the desired direction, the driver experiences a bias force on the hand. Our results suggest that the use of a force-feedback joystick may yield faster learning than the use of a conventional joystick.