Journal of Autism and Developmental Disorders

, Volume 49, Issue 12, pp 4731–4739 | Cite as

Effect of Visual Information on Postural Control in Adults with Autism Spectrum Disorder

  • Yi Huey LimEmail author
  • Hoe C. Lee
  • Torbjörn Falkmer
  • Garry T. Allison
  • Tele Tan
  • Wee Lih Lee
  • Susan L. MorrisEmail author
Original Paper


Sensory processing difficulties affect the development of sensorimotor skills in individuals with autism spectrum disorder (ASD). However, the effect of sensory information on postural control is unclear in the ASD adult population. The present study examined the effect of visual information on postural control as well as the attentional demands associated with postural control in fourteen adults with ASD and seventeen typically developed adults. The results showed that postural sway and attention demands of postural control were larger in adults with ASD than in typically developed adults. These findings indicate that visual processing used for postural control may be different in adults with ASD. Further research in visual field processing and visual motion processing may elucidate these sensorimotor differences.


Autistic disorder Sensory information Visual processing Attention Postural balance Sensorimotor 



The authors would like to acknowledge the contribution of the Australian Government Research Training Program Scholarship and Curtin University Hub for Immersive Visualisation and eResearch in supporting this research. The authors would also like to thank all participants and their families who took part in this study. We gratefully acknowledge the considerable assistance and technical guides of Dr Richard Parsons, Dr Kwang Leng Goh, Dr Jean-Pierre Guillon, Dr Andrew Woods, Paul Davey, Jesse Helliwell, and Joshua Hollick. This study was done in preparation for a Doctor of Philosophy dissertation.

Author Contributions

YHL conceived of the study, participated in its design, performed the measurements, statistical analysis, interpretation of the data, and drafted the manuscript. HL, TF, GA, TT, WLL, and SM participated in the design of the study, interpretation of the data, and drafting of the manuscript. All authors read and approved the final manuscript.


This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Allison, L. K., Kiemel, T., & Jeka, J. J. (2006). Multisensory reweighting of vision and touch is intact in healthy and fall-prone older adults. Experimental Brain Research, 175(2), 342–352. Scholar
  2. American Psychiatric Association. (2015). DSM-5 classification (5th edn.). Washington, DC: American Psychiatric Association Publishing.Google Scholar
  3. Asslander, L., & Peterka, R. J. (2014). Sensory reweighting dynamics in human postural control. Journal of Neurophysiology, 111(9), 1852–1864. Scholar
  4. Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1–11. Scholar
  5. Berencsi, A., Ishihara, M., & Imanaka, K. (2005). The functional role of central and peripheral vision in the control of posture. Human Movement Science, 24(5–6), 689–709. Scholar
  6. Casartelli, L., Molteni, M., & Ronconi, L. (2016). So close yet so far: Motor anomalies impacting on social functioning in autism spectrum disorder. Neuroscience and Biobehavioral Reviews, 63, 98–105. Scholar
  7. Chang, C., Wade, M., Stoffregen, T., Hsu, C., & Pan, C. (2010). Visual tasks and postural sway in children with and without autism spectrum disorders. Research in Developmental Disabilities, 31(6), 1536–1542. Scholar
  8. Cheldavi, H., Shakerian, S., Boshehri, S. N., & Zarghami, M. (2014). The effects of balance training intervention on postural control of children with autism spectrum disorder: Role of sensory information. Research in Autism Spectrum Disorders, 8(1), 8–14. Scholar
  9. Chen, F., & Tsai, C. (2015). A light fingertip touch reduces postural sway in children with autism spectrum disorders. Gait & Posture, 43(1), 137–140. Scholar
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  11. Constantino, J. N., & Todd, R. D. (2005). Intergenerational transmission of subthreshold autistic traits in the general population. Biological Psychiatry, 57(6), 655–660.CrossRefGoogle Scholar
  12. Cornilleau-Peres, V., Shabana, N., Droulez, J. D., Goh, J. C., Lee, G. S., & Chew, P. T. (2005). Measurement of the visual contribution to postural steadiness from the COP movement: Methodology and reliability. Gait & Posture, 22(2), 96–106. Scholar
  13. Crewther, D. P., Crewther, D., Bevan, S., Goodale, M. A., & Crewther, S. G. (2015). Greater magnocellular saccadic suppression in high versus low autistic tendency suggests a causal path to local perceptual style. Royal Society Open Science, 2(12), 150226. Scholar
  14. Deffeyes, J. E., Harbourne, R. T., DeJong, S. L., Kyvelidou, A., Stuberg, W. A., & Stergiou, N. (2009). Use of information entropy measures of sitting postural sway to quantify developmental delay in infants. Journal of NeuroEngineering and Rehabilitation, 6(1), 1–13. Scholar
  15. Donker, S. F., Roerdink, M., Greven, A. J., & Beek, P. J. (2007). Regularity of center-of-pressure trajectories depends on the amount of attention invested in postural control. Experimental Brain Research, 181(1), 1–11. CrossRefGoogle Scholar
  16. Donnellan, A. M., Hill, D. A., & Leary, M. R. (2012). Rethinking autism: Implications of sensory and movement differences for understanding and support. Frontiers in Integrative Neuroscience, 6, 124. Scholar
  17. Doumas, M., McKenna, R., & Murphy, B. (2016). Postural control deficits in autism spectrum disorder: The role of sensory integration. Journal of Autism and Developmental Disorders, 46(3), 853–861. Scholar
  18. Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants & Young Children, 9(4), 23–35.CrossRefGoogle Scholar
  19. Fournier, K. A., Amano, S., Radonovich, K. J., Bleser, T. M., & Hass, C. J. (2014). Decreased dynamical complexity during quiet stance in children with autism spectrum disorders. Gait & Posture, 39(1), 420–423. Scholar
  20. Fournier, K. A., Hass, C. J., Naik, S. K., Lodha, N., & Cauraugh, J. H. (2010). Motor coordination in autism spectrum disorders: A synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 40(10), 1227–1240. Scholar
  21. Fournier, K. A., Kimberg, C. I., Radonovich, K. J., Tillman, M. D., Chow, J. W., Lewis, M. H., … Hass, C. H. (2010). Decreased static and dynamic postural control in children with autism spectrum disorders. Gait & Posture, 32(1), 6–9. Scholar
  22. Haswell, C. C., Izawa, J., Dowell, L. R., Mostofsky, S. H., & Shadmehr, R. (2009). Representation of internal models of action in the autistic brain. Nature Neuroscience, 12(8), 970–972. Scholar
  23. Horak, F. B. (2006). Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls? Age and Ageing, 35(Suppl 2), ii7–ii11. Scholar
  24. Horak, F. B., Nashner, L. M., & Diener, H. C. (1990). Postural strategies associated with somatosensory and vestibular loss. Experimental Brain Research, 82(1), 167–177.CrossRefGoogle Scholar
  25. Hufschmidt, A., Dichgans, J., Mauritz, K. H., & Hufschmidt, M. (1980). Some methods and parameters of body sway quantification and their neurological applications. Archiv fur Psychiatrie und Nervenkrankheiten, 228(2), 135–150.CrossRefGoogle Scholar
  26. Izawa, J., Pekny, S. E., Marko, M. K., Haswell, C. C., Shadmehr, R., & Mostofsky, S. H. (2012). Motor learning relies on integrated sensory inputs in ADHD, but over-selectively on proprioception in autism spectrum conditions. Autism Research, 5(2), 124–136. Scholar
  27. Kohen-Raz, R. (1991). Application of tetra-ataxiametric posturography in clinical and developmental diagnosis. Perceptual and Motor Skills, 73(2), 635–656.CrossRefGoogle Scholar
  28. Lake, D. K., Moorman, J. R., & Cao, H. (2016). Sample entropy estimation using sampen. Retrieved May 5, 2017, from
  29. Lane, S. J., Miller, L. J., & Hanft, B. E. (2000). Towards a consensus in terminology in sensory integration theory and practice: Part 2: Sensory integration patterns of function and dysfunction. Sensory Integration Special Interest Section Quarterly, 23(2), 1–3.Google Scholar
  30. Lim, Y. H., Partridge, K., Girdler, S., & Morris, S. L. (2017). Standing postural control in individuals with autism spectrum disorder: Systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 47(7), 2238–2253. Scholar
  31. Lord, S. R., Rogers, M. W., Howland, A., & Fitzpatrick, R. (1999). Lateral stability, sensorimotor function and falls in older people. Journal of the American Geriatrics Society, 47(9), 1077–1081. Scholar
  32. Marco, E. J., Hinkley, L. B. N., Hill, S. S., & Nagarajan, S. S. (2011). Sensory processing in autism: A review of neurophysiologic findings. Pediatric Research, 69(5 Pt 2), 48R–54R. Scholar
  33. McCleery, J. P., Allman, E., Carver, L. J., & Dobkins, K. R. (2007). Abnormal magnocellular pathway visual processing in infants at risk for autism. Biological Psychiatry, 62(9), 1007–1014. Scholar
  34. Melzer, I., Benjuya, N., & Kaplanski, J. (2004). Postural stability in the elderly: A comparison between fallers and non-fallers. Age and Ageing, 33(6), 602–607.CrossRefGoogle Scholar
  35. Memari, A. H., Ghanouni, P., Gharibzadeh, S., Eghlidi, J., Ziaee, V., & Moshayedi, P. (2013). Postural sway patterns in children with autism spectrum disorder compared with typically developing children. Research in Autism Spectrum Disorders, 7(2), 325–332. Scholar
  36. Memari, A. H., Ghanouni, P., Shayestehfar, M., & Ghaheri, B. (2014). Postural control impairments in individuals with autism spectrum disorder: A critical review of current literature. Asian Journal of Sports Medicine, 5(3), 1–7.CrossRefGoogle Scholar
  37. Milne, E., Swettenham, J., Hansen, P., Campbell, R., Jeffries, H., & Plaisted, K. (2002). High motion coherence thresholds in children with autism. Journal of Child Psychology and Psychiatry, 43(2), 255–263.CrossRefGoogle Scholar
  38. Minshew, N. J., & Keller, T. A. (2010). The nature of brain dysfunction in autism: Functional brain imaging studies. Current Opinion in Neurology, 23(2), 124–130. Scholar
  39. Minshew, N. J., Sung, K., Jones, B. L., & Furman, J. M. (2004). Underdevelopment of the postural control system in autism. Neurology, 63(11), 2056–2061.CrossRefGoogle Scholar
  40. Morris, S. L., Foster, C. J., Parsons, R., Falkmer, M., Falkmer, T., & Rosalie, S. M. (2015). Differences in the use of vision and proprioception for postural control in autism spectrum disorder. Neuroscience, 307, 273–280. Scholar
  41. Mostofsky, S. H., Burgess, M. P., & Gidley Larson, J. C. (2007). Increased motor cortex white matter volume predicts motor impairment in autism. Brain, 130(Pt 8), 2117–2122. Scholar
  42. Parrish, E. E., Giaschi, D. E., Boden, C., & Dougherty, R. (2005). The maturation of form and motion perception in school age children. Vision Research, 45(7), 827–837. Scholar
  43. Paulus, W. M., Straube, A., & Brandt, T. (1984). Visual stabilization of posture. Physiological stimulus characteristics and clinical aspects. Brain, 107(Pt 4), 1143–1163.CrossRefGoogle Scholar
  44. Peterka, R. J., & Loughlin, P. J. (2004). Dynamic regulation of sensorimotor integration in human postural control. Journal of Neurophysiology, 91(1), 410–423. Scholar
  45. Prevision Vision. (2014). 2 Meter 2000 Series Revised ETDRS Chart 1. Google Scholar
  46. Prieto, T. E., Myklebust, J. B., Hoffmann, R. G., Lovett, E. G., & Myklebust, B. M. (1996). Measures of postural steadiness: Differences between healthy young and elderly adults. IEEE Transactions on Biomedical Engineering, 43(9), 956–966. Scholar
  47. Richman, J. S., & Moorman, J. R. (2000). Physiological time-series analysis using approximate entropy and sample entropy. American Journal of Physiology. Heart and Circulatory Physiology, 278(6), H2039–H2049. CrossRefGoogle Scholar
  48. Robertson, C. E., Martin, A., Baker, C. I., & Baron-Cohen, S. (2012). Atypical integration of motion signals in autism spectrum conditions. PLoS ONE, 7(11), e48173. Scholar
  49. Roerdink, M., Hlavackova, P., & Vuillerme, N. (2011). Center-of-pressure regularity as a marker for attentional investment in postural control: A comparison between sitting and standing postures. Human Movement Science, 30(2), 203–212.CrossRefGoogle Scholar
  50. Simmons, D. R., Robertson, A. E., McKay, L. S., Toal, E., McAleer, P., & Pollick, F. E. (2009). Vision in autism spectrum disorders. Vision Research, 49(22), 2705–2739. Scholar
  51. Siu, K.-C., & Woollacott, M. H. (2007). Attentional demands of postural control: The ability to selectively allocate information-processing resources. Gait & Posture, 25(1), 121–126. Scholar
  52. Smoot Reinert, S., Jackson, K., & Bigelow, K. (2015). Using posturography to examine the immediate effects of vestibular therapy for children with autism spectrum disorders: A feasibility study. Physical & Occupational Therapy in Pediatrics, 35(4), 365–380. Scholar
  53. Sutherland, A., & Crewther, D. P. (2010). Magnocellular visual evoked potential delay with high autism spectrum quotient yields a neural mechanism for altered perception. Brain, 133(Pt 7), 2089–2097. Scholar
  54. Takarae, Y., Luna, B., Minshew, N. J., & Sweeney, J. A. (2014). Visual motion processing and visual sensorimotor control in autism. Journal of the International Neuropsychological Society, 20(1), 113–122. Scholar
  55. Teng, Y. L., Chen, C. L., Lou, S. Z., Wang, W. T., Wu, J. Y., Ma, H. I., & Chen, V. C. (2016). Postural stability of patients with schizophrenia during challenging sensory conditions: Implication of sensory integration for postural control. PLoS ONE, 11(6), e0158219. Scholar
  56. Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the short sensory profile. American Journal of Occupational Therapy, 61(2), 190–200. Retrieved from
  57. Travers, B. G., Powell, P. S., Klinger, L. G., & Klinger, M. R. (2013). Motor difficulties in autism spectrum disorder: Linking symptom severity and postural stability. Journal of Autism and Developmental Disorders, 43(7), 1568–1583. Scholar
  58. Vaina, L. M. (1998). Complex motion perception and its deficits. Current Opinion in Neurobiology, 8(4), 494–502.CrossRefGoogle Scholar
  59. van der Kooij, H., Jacobs, R., Koopman, B., & Grootenboer, H. (1999). A multisensory integration model of human stance control. Biological Cybernetics, 80(5), 299–308. Scholar
  60. Warren, W. H., Kay, B. A., & Yilmaz, E. H. (1996). Visual control of posture during walking: Functional specificity. Journal of Experimental Psychology: Human Perception and Performance, 22(4), 818.PubMedGoogle Scholar
  61. Wechsler, D. (2011). Wechsler abbreviated scale of intelligence—Second Edition. Bloomington, MN: Pearson.Google Scholar
  62. Woollacott, M., & Shumway-Cook, A. (2002). Attention and the control of posture and gait: A review of an emerging area of research. Gait & Posture, 16(1), 1–14. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health SciencesCurtin UniversityPerthAustralia
  2. 2.School of Physiotherapy and Exercise Science, Faculty of Health SciencesCurtin UniversityPerthAustralia
  3. 3.School of Mechanical Engineering, Faculty of Science and EngineeringCurtin UniversityPerthAustralia
  4. 4.Pain and Rehabilitation Centre, and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden

Personalised recommendations