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Assessing motor skills as a differentiating feature between high functioning autism and Asperger's disorder

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Maria R Cid
Abstract:
The purpose of this research was to investigate if motor skills could be used as a differentiating feature between Asperger's Disorder (AD) and High Functioning (HFA) in children under the age of 9 years, 0 months, in order to provide additional information regarding the usefulness and validity of distinguishing these two disorders. There is continued controversy over whether the two disorders differ because there is a lack of a consistent set of diagnostic instruments and criteria for clinicians to use when diagnosing disorders within the autism spectrum. The research design employed was a non-experimental, causal comparative study. The study's methodology involved randomly selecting a sample population from a database of archived records of individuals who met the special education eligibility criteria for autism maintained by Clark County School District in Las Vegas, Nevada. Forty-six records were identified as matching the study parameters and comprised 10 girls aged 3-6 and 36 boys aged 3-7 years. The data was analyzed using the SPSS statistical software package. The independent t test was used to test the significance of the difference between the means of the two groups in the study. The results revealed that, with respect to motor skills, there was a significant difference between the AD and HFA groups.

vi Table of Contents Acknowledgments …………………………………………………………….…… v

List of Tables ……………………………..……………………………….……. ix CHAPTER 1. INTRODUCTION………………………………………………………… .. 1 Background of Study………………………………………………………………..3 Statement of the Problem……………………………………………………………7 Purpose of the Study…………………………………………………………………8 Research Questions………………………………………………………………….8 Nature of the Study………………………………………………………………….9 Significance of the Study……………………………………………………………9 Rationale for the Study .............................................................................................. 10 Definition of Terms ................................................................................................... 10 Assumptions .............................................................................................................. 11 Limitations ................................................................................................................. 12 Summary .................................................................................................................... 12 CHAPTER 2. LITERATURE REVIEW ............................................................................... 14 Introduction ............................................................................................................... 14 History ....................................................................................................................... 16 Prevalence .................................................................................................................. 18 High Functioning Autism Versus Asperger’s Disorder ............................................ 20 Developing a Clinical Label for High-Functioning Autism ...................................... 23 Differences between Aѕperger’ѕ Disorder and High-Functioning Autism ............... 24 Differentiating between Asperger’s Disorder and High-Functioning Autism .......... 32 Conclusion ................................................................................................................. 34

vii Summary .................................................................................................................... 36 CHAPTER 3. METHODOLOGY ......................................................................................... 39 Research Design and Appropriateness ...................................................................... 40 Research Questions.................................................................................................... 41 Null Hypothesis ......................................................................................................... 41 Target Population ...................................................................................................... 42 Variables .................................................................................................................... 44 Instruments and Validity ........................................................................................... 45 Data Collection Procedures ....................................................................................... 48 Data Analysis ............................................................................................................. 49 Summary .................................................................................................................... 52 CHAPTER 4. DATA ANALYSIS AND RESULTS ............................................................ 53 Review of Research Questions, Hypotheses, and Target Population ........................ 53 Sampling and Data Collection Procedures ................................................................ 54 Data Analysis ............................................................................................................. 55 Results ....................................................................................................................... 57 Discussion of Results................................................................................................. 67 Summary .................................................................................................................... 72 CHAPTER 5. CONCLUSION, IMPLICATIONS, AND RECOMMENDATIONS ............ 73 Summary of the Study ............................................................................................... 73 Summary of Results................................................................................................... 75 Conclusion ................................................................................................................. 76 Limitations ................................................................................................................. 79 Implications for Future Studies ................................................................................. 81

viii Recommendations ..................................................................................................... 82 REFERENCES ...................................................................................................................... 84 APPENDIX A. APPROVAL TO CONDUCT RESEARCH ................................................ 89 APPENDIX B. DATA COLLECTION PROTOCOL .......................................................... 91 APPENDIX C. SYNOPSIS OF DATA COLLECTED ........................................................ 92 APPENDIX D. FREQUENCY OF MOTOR SCORE .......................................................... 93 APPENDIX E. RESULTS FOR INDEPENDENT T TESTS ............................................... 94 APPENDIX F. COMPARISON OF MEANS OF MOTOR SCORE ................................... 96 APPENDIX G. MEANS PLOT FOR AGE........................................................................... 97 APPENDIX H. MEANS PLOT FOR FSIQ .......................................................................... 98 APPENDIX I. ANCOVA OUTPUT RESULTS ………………………………… ............99 APPENDIX J. RESULTS OUTPUT FOR REGRESSION ANALYSIS…………………100

ix List of Tables

Table 1. Sample of Data Entry Screen for Demographic and Variable Listing ……………58 Table 2. Descriptive Statistics for Age, FSIQ, and Motor Score …………………………...59 Table 3. Descriptive Statistics for Motor Score, FSIQ, and Age vs. HFA/AD ……………..60 Table 4. Frequency Analysis for Race and Gender Variables …………………….……….61 Table 5. Frequency Analysis by Age, Gender, and Type of Disorder (HFA or AD) ….........62 Table 6. Tests of Normality …………………………………………………………………63 Table 7. Group Statistics for AD/HFA versus Age ……………………………………………...64 Table 8. Group Statistics for AD/HFA versus IQ …………..………………………………65 Table 9. Group Statistics for AD/HFA vs. Motor Skills ……………………………………67 Table E1. Independent Samples Test for AD/HFA versus Age ……………………………..95 Table E2. Independent Samples Test for AD/HFA versus IQ ………………………………95 Table E3. Independent Samples Test for AD/HFA vs. Motor Skills ………………………..96 Table I1. Tests of Between-Subjects Effects …………………………………………….100 Table I2. Tests of Between-Subjects Effects-Controlling for IQ……………………….….100 Table J1. Model Summary without Disorder (HFA/AD) …………………………….……101 Table J2. ANOVA b …………………………………………………………………...…101 Table J3. Coefficients a …………………………………………………………………...102 Table J4. Model Summary for Disorder (HFA/AD)…… …………….....102 Table J5. ANOVA b …… ……………………………………………….……………...103 Table J6. Coefficients a …………………………………… ……….…………….….103

1 CHAPTER 1. INTRODUCTION

Autism disorders are neurologically based disorders that are best understood as composing part of a spectrum in which multiple and interacting influences, both biological and environmental, determine the severity and the variation of the impairments within the syndrome. The spectrum is a continuum that begins with the higher functioning or least impaired individual to the lower functioning and most impaired individual. The disorders under the spectrum that are the topic of this study are Asperger’s Disorder (AD) and High Functioning Autism (HFA). The individual with AD is at the highest end of the spectrum and, thus, is higher functioning than the individual with HFA. Regardless of the severity of the disorder, or where the individual falls within the spectrum, all individuals exhibit developmental deficits in three major areas: social interactions, language, and “restricted repetitive and stereotyped patterns of behavior, interests, and activities” (American Psychiatric Association, 1994, p. 75). During the past 10 years, autism spectrum disorders (ASDs) and their increasing numbers have steadily moved to the forefront of developmental disabilities because of the impact these impairments have on the child’s immediate and long-term academic and social success. The dramatic increase is evident when researchers consider that, in 1999, studies reported that autism affected 1 child in 2,500 with a ratio of about four to five affected males per female (Silverman & Weinfeld, 2007). A mere three years later, in 2002, the Autism Society of America reported that ASDs were occurring at a rate of 1 in every 166 births, with a ratio of four affected males per female (Silverman & Weinfeld). In 2007, the Centers for Disease Control (CDC) reported that approximately 1 in 150 children in the United

2 States have autism or another spectrum disorder (Silverman & Weinfeld). As research continues and study data emerges, the number of children diagnosed with a disorder within the autism spectrum continues to rise. According to Kogan et al. (2009), on October 5, 2009, the Department of Health and Human Services National Survey of Children's Health reported that one out of every 91 children had an autism spectrum disorder. This means that 1% of American children had been diagnosed with some form of autism. Such a dramatic increase in prevalence from 1 in 2,500 to one in 91, has led to the development of several theories that attempt to explain the escalating rate of ASDs. One theory suggests that new estimates do not necessarily indicate that autism is on the rise because the criteria and definitions used to characterize autism are not the same as those used prior to this decade. Thus, the revised criteria may have contributed to the rising numbers. Another explanation for the increase suggests estimates appear to have risen because there is no simple test to provide a definite diagnosis (Howlin, 1999); therefore, the lack of adequate diagnostic instruments may increase the risk for misdiagnosis, which, in turn, could cause an inflation of the actual autism numbers. The current prevalence of autism may also be attributed to the fact that most research studies are not derived from clinical exams but from descriptive reports provided by teachers and other professionals working with the ASDs population. The descriptive reports are collected and reviewed by experts for key words that only suggest a diagnosis of autism, AD, or a related disorder, and do not necessarily give a diagnosis of a spectrum disorder. The dilemma with this type of research is that the researcher must assume the reported information is both valid and accurate because there is no way of proving otherwise (Howlin, 1999). This assumption may lead to individuals being mislabeled or misdiagnosed,

3 thus, once again, causing the appearance of an increase in the number of individuals diagnosed with a disorder within the autism spectrum. Siegel (2003) reported that the criteria for diagnosing autism and its related disorders have been expanded to include subtle and wide-ranging forms of early developmental delays. Both clinical and educational professionals diagnose individuals with these early forms of developmental delays with a disorder within the autism spectrum in an effort to secure better services for the developmentally delayed client. This practice may also have contributed to the increase in the number of children who are diagnosed with an ASD. A final explanation for the rate increase is the addition of AD to the Diagnostic and Statistical Manual of Mental Disorders (DSM – IV). Prior to 1994, AD was not accepted as a specific classification or form of autism. The addition of AD to the spectrum has certainly added breadth and numbers to the overall spectrum. Macias (2004) posited that there are many possible explanations for the increase in the number of individuals identified within the spectrum. However, it is important to note that regardless of the cause or reasons proposed for the increase, there is no doubt the numbers are increasing at an alarming rate (Macias).

Background of Study Autism disorders fall within a spectrum that ranges from the most severely impaired to the least impaired. Three disorders subject to controversy and ranging from the most severe to the least are Autism, Asperger’s Disorder, and Pervasive Developmental Disorder – Not Otherwise Specified. The most challenging of these three subtypes to differentiate are autism of the high functioning type and Asperger’s Disorder. Further, not only are these two

4 subtypes difficult to differentiate, but they are also, quite frequently, diagnosed and treated as one and the same (Klin & Volkmar, 1995; Baron-Cohen & Wheelright, 1999). The addition of AD to the DSM – IV has helped establish a frame of reference for clinicians. The DSM – IV has established the following criteria for AD: A. Qualitative impairment in social interaction, as manifested by at least two of the following: 1. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction 2. Failure to develop peer relationships appropriate to developmental level 3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) 4. Lack of social or emotional reciprocity B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: 1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus 2. Apparently inflexible adherence to specific, nonfunctional routines or rituals 3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) 4. Persistent preoccupation with parts of objects C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. (American Psychiatric Association, 2000, p. 84)

Nonetheless, the limited research available has only added to the differentiation difficulties (Baron-Cohen & Wheelright, 1999; Fombonne, 1998). The DSM – IV does not recognize HFA as a separate disorder; therefore, there are no guidelines specified for HFA (Gillberg & Ehlers, 1998). Clinicians use the established criteria for diagnosing autism

5 disorder to diagnose HFA. A diagnosis of autistic disorder is made when the following criteria from A, B, and C are all met: (A) A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): 1. Qualitative impairment in social interaction, as manifested by at least two of the following: (a) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (b) Failure to develop peer relationships appropriate to developmental level (c) A lack of spontaneous seeking to share enjoyment, interests, or achievements with others (e.g., by a lack of showing, bringing, or pointing out objects of interest) (d) Lack of social or emotional reciprocity 2. Qualitative impairments in communication as manifested by at least one of the following: (a) Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) Stereotyped and repetitive use of language or idiosyncratic language (d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level 3. Restricted, repetitive, and stereotyped patterns of behavior, interest, and activities, as manifested by at least one of the following: (a) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b) Apparently inflexible adherence to specific, nonfunctional routines or rituals (c) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) (d) Persistent preoccupation with parts of objects (B) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. (C) The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder. (American Psychiatric Association, 2000, p. 75)

Other features clinicians consider but are not included in the DSM- IV criteria for autism or AD are in the areas of cognition and motor skills. Children with AD tend to score

6 in the average to above-average range on standardized cognitive assessments. In addition, an analysis of the full-scale intelligence quotient (IQ) indicates that an AD child’s Verbal IQ standard score is usually higher than the Performance IQ standard score (Gillberg & Ehlers, 1998). On the other hand, children diagnosed with autism score the opposite: a higher performance score and a lower verbal score when compared to a same age AD peer (Gillberg & Ehlers). Motor-skills deficit is another characteristic that clinicians consider as a feature of AD, but is not included as a criterion in the DSM-IV. Studies suggest that children with autism do not exhibit motor deficits whereas children with AD do present deficits in either fine or gross motor skills or in both motor skills areas (Baron-Cohen & Wheelright, 1999). A few studies suggest that gross and fine motor skills should be added as a mandatory criterion to the DSM – IV classification of AD (Baron-Cohen & Wheelright). These studies allege that motor-skill deficits have been recognized in individuals with AD since Hans Asperger first described the disorder in 1944. Asperger described his case participants as not exhibiting speech delays but presenting with motor deficits (Asperger, 1944, as cited in Firth, 1991). Lorna Wing (1981), in her description of the clinical features of AD, included the following statement, “clumsy and ill coordinated movement and odd posture” (p. 24); however, this initial research by these pioneers of AD has not been strong enough to warrant the inclusion of motor skills deficits in the DSM – IV criteria. Some current research studies posit that motor-skill deficits are present in children with AD and should be used as a criterion to differentiate between HFA and AD (Ghaziuddin, Tsai, & Ghaziuddin, 1992; Macias, 2004). Other recent studies, however, have refuted these findings (Ozonoff, Dawson, & McPartland, 2002). Ozonoff et al. (2002)

7 further posited that there is no clear definition of motor skills and recommended that the research community should first develop a consistent and widely accepted definition for motor skills before motor-skill deficits can be considered as a differentiating criterion. Unfortunately, the predicament with the motor-skills controversy is that a review of literature indicates only a few studies have investigated motor-skill deficits as a criterion for differentiating HFA and AD (Green et al., 2002). The literature indicates that not enough research studies have been conducted to support the inclusion of motor-skill deficits as a differentiating citerion to be used when considering an HFA or AD diagnosis. This study researched the use and appropriateness of motor-skill deficits as a criterion to differentiate HFA from AD in children under the age of nine years.

Statement of the Problem Even though some studies and research projects have suggested that below-average gross or fine motor-skills or both may be considered a feature that can be associated with AD and not with HFA (Ghaziuddin et al., 1992; Macias, 2004), other research results posited that motor-skill deficits are not a consistent feature of AD (Ozonoff et al., 2002). Thus, based on this information, more research is needed to determine whether motor skills, in fact, can be considered a symptomatic distinction between AD and HFA. The goal of this study was to research whether or not motor skills could be considered as a distinguishing criterion associated with AD and not with HFA.

8

Purpose of the Study A number of research studies (Ghaziuddin et al., 1992; Macias, 2004) have concluded that children with HFA demonstrate motor skills within the average range whereas children with AD demonstrate deficits in motor skills. The purpose of this study was to determine whether or not motor skills might be used as a criterion to differentiate AD from HFA. Specifically, this study sought to verify if motor skills could be considered as a distinguishing criterion associated with AD and not with HFA in children under the age of 9 years, 0 months. Thus, the results of this study may provide support for the hypothesis that motor skills may be used to differentiate individuals with HFA from individuals with AD. The study results may not only lead to a differential diagnosis, but might also lead to the development and implementation of appropriate individualized educational programs as well as apposite treatment plans. The correct diagnosis and the proper intervention may help children with either HFA or AD learn to triumph over their deficits and eventually develop into productive members of society.

Research Questions The primary research question for this study was, “Can motor-skill adaptive levels, as reported by parents on the Vineland, be used to differentiate HFA from AD?” An additional specific question researched in this study was, “Is there a mean difference in Vineland Composite Motor Skills scores between individuals with HFA and individuals with AD?” The results might suggest that individuals with AD have motor skills deficits whereas individuals with HFA do not exhibit motor skills insufficiency.

9 Nature of the Study The version of the non-experimental approach employed in this study was causal comparative (ex-post facto method). This type of research design studies the relationships among variables that do not meet the criteria for true experimental research. In most situations, causal-comparative research does not meet the criterion for random assignment of participants from a single group. In this type of research, the independent variable (the cause) has already happened and, thus, cannot be manipulated; so the researcher has no control over it (Gay & Airasian, 2003). Thus, the independent variable would be one that cannot be manipulated; examples of these are gender, age, and IQ. The dependent variable would be the effect to be compared between the groups (at least two). Research suggests that, when using preexisting data, this approach is the most appropriate (Gay & Airasian).

Significance of the Study An appropriate and an early diagnosis leads to immediate access to interventions. Huang and Wheeler (2006) posited that children diagnosed by age three who attend day programs, developed to address autism related difficulties exhibit significant improvement when compared to children who are diagnosed at a later age, attending the same type of day program. Thus, an accurate diagnosis will not only give a child access to appropriate services but also pave the way for long-term academic and social success (Lord & McGee, 2001). The results of this study may assist professionals in making a differential diagnosis of either High-Functioning Autism (HFA) or Asperger’s Disorder (AD). Finally, as professionals wrestle with these two similar, yet distinct, disorders within the autism spectrum, the results of this study and other similar studies may lead to the DSM

10 – IV criteria being modified to include motor skills as a differentiating criterion. In addition, the current study may encourage other investigators to pursue similar research. Further studies might strengthen the hypothesis that motor skills can be used as a criterion to differentiate AD from HFA.

Rationale for the Study Thе рurроѕе оf thе рrеѕеnt rеѕеаrсh wаѕ tо assess motor skills as a differentiating feature bеtwееn AD аnd HFА in children under the age of nine years. The goal of this study was to provide аdditiоnаl infоrmаtiоn rеgаrding thе uѕеfulnеѕѕ аnd vаlidity оf diѕtinguiѕhing bеtwееn thеѕе twо diѕоrdеrѕ within the autism spectrum. Current literature is not only ambiguous but also contradictory on the acceptance of the theory that individuals with AD show a more distinct motor-skill deficit or developmental delay than their HFA peers. This reasearch study may add to the body of literature in this topic domain and provide credibility to using motor skills as a differentiating feature between AD and HFA. The importance of the research lies in providing clinicians and other educational and health care professionals with concrete information that may improve their ability to differentiate between the two disorders. In addition, the results of the study may assist the aforementioned professionals to make more accurate diagnoses, which, in turn, may lead to more appropriate treatment and educational programs for the individual concerned.

Definition of Terms Definitions of key terms used herein are provided to ensure understanding of the context of this research study. The study constructs included Motor Skills, High-Functioning Autism (HFA), and Asperger’s Disorder (AD). The dependent variable was Motor Skills

11 (Gross and Fine); the independent variable was the Diagnosis (HFA vs. AD). The following definitions apply to this research study. Asperger’s Disorder. Refers to the disorder with symptoms identical to those given for autistic disorder, except that the child is not required to demonstrate significant difficulties in the communication domain and has an average to above average IQ (Wing, 1981). Fine Motor Skills. How an individual uses hands and fingers to manipulate objects. Gross Motor Skills. How an individual uses arms and legs for movement and coordination. The HFA diagnosis. Refers to the diagnosis given to a child who meets the criteria for autism and has an average IQ.

Assumptions The data source was an archived database. This required associating a few assumptions with this research study. First, data gathering required that the selected records be matched for age, gender, and IQ. The next assumption was that age and gender would not affect the motor scores. It was also assumed that IQ may affect motor skills scores. Finally, it was assumed that the age limit set for the study would suffice for the purposes of this study: age was limited to records between the ages of 2 years, 10 months and 9 years, 0 months.

12

Limitations The basic causal-comparative design involved selecting two groups that differed on a particular variable of interest (HFA and AD) and then comparing them on another variable (Vineland motor skills composite score). This specific research design sought to identify associations among variables (motor skills) as well as attempted to determine the cause or consequences of differences that already exist between or among groups of individuals (HFA and AD). This type of research design is not without limitations. Important major weaknesses in causal-comparative research are the lack of randomization and the inability to manipulate an independent variable. A threat to internal validity was plausible in the form of possible subject selection bias. For the purpose of this investigation, the procedure implemented to reduce this type of threat was to match archived records by gender, age, and IQ. Additional threats to internal validity included (a) the study was limited to one location (Clark County, Las Vegas, Nevada) and may generalize best to locations with population similar to Clark County; and (b) only those archived records that had recorded results of a cognitive assessment, the GARS (Gilliam, 1995, 2000), GADS (Gilliam, 2001), and Vineland (Sparrow, Balla, & Cicchetti.,1984, 2005) were selected for the study.

Summary Autism spectrum disorders (ASDs) are neurologically based disorders of development. The disorders under the spectrum that were the topic of this study were Asperger’s Disorder (AD) and High Functioning Autism (HFA). During the past decade,

13 there has been a sharp increase in the number of individuals diagnosed with autism and related disorders. Some theories suggest that the new estimates do not necessarily indicate that autism is on the rise because the criteria and definitions used to characterize autism have changed over the past decade. Others suggest that estimates appear to have risen because there is no simple test to provide a definitive diagnosis (Howlin, 1999). Chapter 1 presented a discussion of the problem of a lack of a consensus on establishing diagnostic criteria for AD and HFA. There is continued controversy over whether AD and HFA are, in fact, different or, indeed, exactly the same disorder. The purpose of the current non-experimental, causal comparative study was to verify if motor skills could be considered as a distinguishing criterion associated with AD, and not with HFA, in children under the age of nine years zero months. Chapter 2 presents relevant literature associated with the criteria currently used to diagnose HFA and AD. In particular, research studies that reported the use of motor skills as a differentiating criterion were reviewed and analyzed. Chapter 3 discusses the study’s research methodology, design, target population, and procedures for selecting the participant records and analyzing the data. Chapter 4 presents the analysis of the data and the results. Chapter 5 discusses conclusions drawn from the results of the data analysis. In addition, study limitations and how these may have affected the results of the study are discussed. Finally, suggestions for future studies are made.

14

CHAPTER 2. LITERATURE REVIEW

Introduction Autism is a behavioral syndrome with a neurological etiology that includes abnormalities of language and thinking skills, repetitive behavior such as rocking, abnormal responses to sensations, people, events and objects, and self-injurious behavior (Warren, 1986). Other characteristics often associated with autism are engagement in repetitive activities and stereotypical movement, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance (Crawford, Wilson, & Dewey, 2001). The neurological basis of autism’s many ѕenѕorimotor features, including stereotypical behaviors, is unknown. Attention and sleep are the most affected and one third of individuals experience epilepsy through adulthood. Whether or not this sub-clinical epilepsy plays a role in the developmental regression of one third of the toddlers who loѕe language skills and become autistic remains to be determined. Autism is one of five disorders that show varying degrees of impairments in the same three domains: social functioning, communication, and behavioral variability. The other disorders are Rhett’s Disorder, Childhood Disintegrative Disorder (CDD), Asperger’s Disorder (AD), and Pervasive Developmental Disorder-Not Otherwise Specified (PDD- NOЅ). Since each of these disorders overlap in varying degrees of impairments in these three domains, they are considered to fall within a spectrum of disorders called Pervasive Developmental Disorders (Crawford et al., 2001, pp. 29-50).

15 The literature suggests that of the five disorders that make up the spectrum, some are easy to diagnose and others are more complicated (Croce, Horvat, & McCarthy, 2001, p.276). For example, Rett Syndrome and Fragile X Syndrome are relatively unequivocal disorders, and thus are more likely to be correctly diagnosed. Claѕѕic autism is also one of the spectrum disorders that are unambiguous. Children with claѕѕic autism are usually nonverbal, unengaged, and do not perform well on standardized diagnostic assessments (Croce et al., 2001, pp. 275-280). Individuals who are high functioning and demonstrate clearly autistic behaviors are on the other side of the spectrum (Croce et al., 2001, pp. 275-280). Some of these individuals, depending on age, use meaningful language, read, write, do math, show affection, complete daily taѕkѕ, but have difficulties sustaining eye contact, maintaining a conversation, engaging in play, and/or picking up on social cues. Diagnosing and suggesting treatment for these individuals is often a dilemma for clinical professions. Clinicians must determine if the individual who is at the high end of the spectrum should be given the diagnosis of Pervasive Developmental Not Otherwise Specified (PDD-NOЅ), High Functioning Autism (HFA), or Asperger’s Disorder (AD; Croce et al., 2001, pp. 275-280). Thus, determining the most appropriate diagnosis is a serious dilemma clinical professionals face. The appropriate diagnosis may determine services for the individual; the appropriate services may affect the type of treatment he/she receives as well as the individual’s short and long term social, academic, and employability success.

Full document contains 112 pages
Abstract: The purpose of this research was to investigate if motor skills could be used as a differentiating feature between Asperger's Disorder (AD) and High Functioning (HFA) in children under the age of 9 years, 0 months, in order to provide additional information regarding the usefulness and validity of distinguishing these two disorders. There is continued controversy over whether the two disorders differ because there is a lack of a consistent set of diagnostic instruments and criteria for clinicians to use when diagnosing disorders within the autism spectrum. The research design employed was a non-experimental, causal comparative study. The study's methodology involved randomly selecting a sample population from a database of archived records of individuals who met the special education eligibility criteria for autism maintained by Clark County School District in Las Vegas, Nevada. Forty-six records were identified as matching the study parameters and comprised 10 girls aged 3-6 and 36 boys aged 3-7 years. The data was analyzed using the SPSS statistical software package. The independent t test was used to test the significance of the difference between the means of the two groups in the study. The results revealed that, with respect to motor skills, there was a significant difference between the AD and HFA groups.