Visual, Spatial, and Motor Assessment

, Marcy Willard¹ and Helena Huckabee¹

(1)

Emerge: Professionals in Autism, Behavior and Personal Growth, Glendale, CO, USA

Abstract

Visual, Spatial, and Motor Assessment are associated areas of a comprehensive evaluation for an Autism Spectrum Disorder. Visual Spatial skills include visual perception, visual closure, visual processing, and visual figure ground. Impairments may include visual tracking and planning, hand eye coordination, and reading a map. Measures often used to assess visual-spatial skills in ASD include the MVPT-3, Perceptual Reasoning tasks on the WISC-IV, Visual Spatial tasks on the WISC-V, Spatial tasks on the DAS-2 Preschool, The Beery Test of Visual Perception and the Rey Complex Figure Test (RCFT) copy trial, or WMS-IV copy trial for Visual Reproduction. In the motor domain, children may have challenges with oral motor skills related to muscle tone that may include chewing, swallowing, and drooling. Fine motor deficits may relate to fine motor dexterity, handwriting, manipulation of beads or coins and can be assessed by a number of measures. In younger children, cognitive measures like the Mullen Scales include motor skills assessment. The Vineland-2 also provides sections for parents to report motor skills from birth to age six. Additional assessments like the Beery VMI Sequence, informal drawing and writing tasks, and the Grooved Pegboard can provide information on fine motor skills. By assessing these Associated Areas, a clinician can offer more targeted recommendations for treatment of these symptoms that may be present in an individual with ASD.

Keywords

Visual-motor in ASDVisual planning in ASDVisual memory in ASDFine motor in ASDGross motor in ASDLow tone in ASDHandwriting in ASDLocal vs. global processing in ASD

Assessing for Visual-Spatial Skills

Vignette #5 Tom: Visual-Spatial Assessment in a Child with a Scattered Verbal/Nonverbal Profile

Tom, age 10, was referred for an evaluation at Emerge to rule out the presence of an Autism Spectrum Disorder (Table 10.1). Parents reported a significantly scattered academic and cognitive profile for Tom that seemed to provide immense challenges to educators as they worked with him. Tom had a history of not speaking in sentences until first grade and not reading until third grade. He used sign language to communicate as a young child and he had challenges with peers, biting others in pre-kindergarten, for example. Tom’s parents reported that he uses many gestures, enjoys pretend play, and is quiet and sweet at home. He had sensory sensitivities to taste and texture that sometimes caused challenges with meal time and dressing. Tom displayed a restricted interest in Legos .

Table 10.1

Assessing for visual-spatial skills

Associated area

1. Visual spatial

•Visual Perception: Consider WISC-IV Perceptual Reasoning or WISC-V Visual Spatial Index Score, Motor-Free Visual Perception Test (MVPT): visual closure, visual figure ground, visual rotation

•Visual Memory: visual working memory, picture span test on WISC-V, WMS, MVPT visual memory items, VMI-Visual Perception test

•Visual Planning: consider performance on Tower of London, and CTMT (Trails)

•Central Coherence (Local vs. Global Processing)

•Consider discrepancies between Language and Visual Spatial: visual develops before language in ASD

•Consider Results from: Beery VMI, CTMT, MVPT-III, Picture Span: WISC-V, TOL-II, VOT

Full measure names

Beery—Buktenica Developmental Test of Visual—Motor Integration (VMI), Sixth Ed.

Beery—Buktenica Developmental Test of Visual Perception, Sixth Ed.

Beery—Buktenica Developmental Test of Motor Coordination, Sixth Ed.

Comprehensive Trail Making Test (CTMT)

Motor-Free Visual Perception Test, Third Ed. (MVPT-III)

Picture Span Subtest on WISC-V

Tower of London, Second Ed. (TOL-II)

Hooper Visual Organization Test (VOT)

Tom scored in the Superior range for Perceptual Reasoning on the WISC-IV and his Verbal Comprehension abilities were Mildly Impaired. This clinically significant differential in scores occurs in less than one percent of the population. Tom scored in the Superior range on Motor Free Visual Perception (MVPT-3) and Visual Memory (TOMAL), but his CELF-4 score fell in the Mildly Impaired range. Tom was somewhat impulsive at times and needed frequent breaks to maintain focus. He did not speak spontaneously during the first 30 min of testing. However, he was able to answer questions like “What do you like to do for fun?” (I play with Legos) and “Where do you live?” (I live in a duplex with my family.). On The ADOS-2, he did well with gesture and pretend play, but struggled to tell a story from a book, have a reciprocal conversation, or describe relationships. His reported “best friend” was the child who most often teased him at school.

Taken together, Tom’s profile was indicative of an Autism Spectrum Disorder. Tom had been underserved in school as teachers did not realize he had such strengths in Visual Spatial skills and nonverbal domains. His parents decided to pursue private schooling based on this unique profile and Tom began to make progress particularly in math and science. Tom started ABA therapy to address his communication and social interaction weaknesses and he has begun to make friends with common interests like Legos and drawing.

A 1-year follow-up evaluation revealed much improved verbal skills. Anecdotally, he talked with examiners the whole time he was being assessed during this follow-up session. He also showed a significant improvement in verbal skills as evidenced on standardized langu age testing.

Visual-Spatial Assessment as It Applies to Autism

As introduced in the Language section of Chap. 8, weak Central-Coherence theory refers to an inability to integrate information from the environment into a meaningful whole, focusing on local stimuli and not on global meaning. Individuals with weak coherence have a detail-focused style of processing that is often characteristic of ASD (Happé & Frith, 2006, p. 5). When we think of visual-spatial assessment as it applies to ASD, we often think of that characterization of “Rain Man,” an individual with very specific strengths in the visual-spatial realm but an inability to integrate these skills in a more global manner. Of course, this is only one very specific example of an individual with significant impairment and in no way represents the variation of presentations across the Spectrum.

Individuals with ASD who have weak language skills may present with exceptional talent in artistic areas. Deborah Fein writes in her book The Neuropsychology of Autism (2011) that the visual-spatial cortex develops earlier than the language cortex and thus may be spared in individuals with ASD. This is also consistent with Piaget and Vygotsky’s models for development. Studies have shown that tasks requiring local processing are often easier or skills are at minimum intact in individuals with ASD while global processing deficits are noted. Attention to detail on a task like Block Design may lead to high scores initially as the individual can look at each block and the individual pattern. As the figures are more complex and it is helpful to see the figure as a whole and not as a sum of parts, performance may decline. Fein (2011) notes (p. 100) that a cognitive style favoring detail-oriented processing has been found in family members of those diagnosed with ASD.

This weak Central-Coherence theory fits with neuroimaging data highlighting under-connectivity in the white matter of the brain, which may cause problems with global or higher order processing (Fein, 2011, p. 101). Just, Cherkassky, Keller, Kana, and Minshew (2007) completed a study utilizing the Tower of London, an executive functioning measure, and found that individuals with ASD exhibited underactivity between the frontal and parietal areas of the brain. The way brain function was altered indicated less communication across cortical areas. A cross-section of the corpus callosum showed that relevant parts utilized in the autistic brain were smaller than in controls. The study concluded that there is a deficit in integration of information at neural and cortical levels in ASD (Just et al., 2007). Studies including individuals with ASD and a comparison group of neurotypical children, matched for IQ, show that individuals with ASD struggle with integration across the language and imagery functions of the brain (Willard, 2013).

Connectivity m ay be characterized by local over-connectivity and long distance under-connectivity or weaker long range connections between brain regions. In 40 adolescents and young adults, Anderson, Nielsen et al. (2011) found differences in connectivity in the brain between control subjects and those with autism. Unaffected siblings’ brains were more similar to controls than to the individuals diagnosed on the Spectrum (Anderson, Druzgal et al., 2011). These data support the idea that we may find localized strengths in areas like visual-spatial skills for those with ASD. We may also find that global processing is impaired, so a task that draws on many brain regions to complete is likely to be more difficult for an individual on the spectrum.

Another theory worth reviewing is that of systemizing and empathizing introduced by Simon Baron-Cohen and detailed in Baron-Cohen and Sally Wheelwright’s chapter in the Neuropsychology of Autism, edited by Deborah Fein (2011). While a systematizing approach involves understanding the system and looking at the specifics, an empathizing perspective includes making sense of the behaviors of others and encompasses Theory of Mind. Empathy involves attributing mental states to oneself and others and having an emotional reaction like sympathy (Baron-Cohen, 2004).

Systemizing is a drive to analyzing systems (Baron-Cohen, 2004). Strong visual-spatial skills in recalling or reproducing detail may be part of a systemizing approach. There are rules and clear structures that can be relied on when understanding visual patterns . Patterns have detail, involve concrete elements, and tend to have clear and logical solutions. The emotions and perspectives of others do not lend well to such logical algorithms and systematic analysis. Billington, Baron-Cohen, and Wheelwright (2007) propose that individuals with ASD take a systemizing approach to the world thus making social understanding very difficult because it does not have an exact recipe.

The chef metaphor is pertinent here. Someone who is systemizing will consistently produce dishes that follow the recipe precisely every time. This exacting approach is very useful in some situations. A non-systemizing approach would look much different in the culinary arts. A chef may change ingredients, throw this or that, until it ‘tastes right.’ The consequences of such spontaneity could be delicious or disastrous, but they are not predictable. In the chef metaphor here, individuals with ASD would generally prefer the precise recipe approach over the dynamic style of the more spontaneous chef.

Only gold members can continue reading. Log In or Register to continue