The effect of posture, hand functions and sensory processing skills on nutrition in children with autism spectrum disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder typically characterized by difficulties in social communication, unusual and restricted interests, and repetitive behaviors observed in early childhood. Children with ASD may experience problems related to posture, balance, postural control, hand skills, gait, sensory integrity, nutrition, and motor development at different stages of their lives, ultimately affecting their quality of life negatively. This study investigates the relationship between posture, balance, hand functions, sensory processing skills, and nutrition in children with ASD. The study included 40 children diagnosed with ASD (study group) aged between 5-10 years and their parents, as well as 40 typically developing children (control group) and their parents. All children underwent postural assessments, including measurement of craniovertebral angle (CVA) for head posture and Pediatric Balance Scale (PBS) for postural control; hand function assessments, including Jebsen Taylor Hand Function Test (JTHFT) for hand skills and Jamar hand dynamometer for hand grip strength; sensory processing assessments using Dunn Sensory Profile; nutrition problem assessments using the Screening Tool of Feeding Problems (STEP) and The Brief Autism Mealtime Behavior Inventory (BAMBI); and evaluation of life quality using the Pediatric Quality of Life Inventory–Parents Form (PedsQL–Parents Form). The Beck Depression Scale (BDI), Beck Anxiety Scale (BAI), and Trait-State Anxiety Scale were used to assess parents depression, anxiety, and anxiety status. Data analysis was performed using SPSS v.22, with a significance level of p<0.05. Significant differences favoring the control group were observed in terms of CVA angle, PBS score, JTHFT sub-parameter values, hand grip strength values, all STEP sub-group scores except for aspiration risk, BAMBI total scores, PedsQL–Parents Form score, and parents' BDI, BAI, and Trait-State Anxiety Scale scores (p<0.05). In children with ASD, a moderately negative correlation was observed between the PDS score and all values except for the 'checkers' sub-parameter of JTHFT, a moderately positive correlation between grip strength, a negative moderate-level relationship was found between all JTHFT sub-parameter values except for 'checkers' and hand grip strength values (p<0,05). The emotional scores of PedsQL–Parents Form in children with ASD were moderately negative correlation with parents' BDI, BAI, State Anxiety and Trait Anxiety scores, and total scores of PedsQL–Parents Form were moderately negative correlation with parents' BDI scores (p<0,05). A moderate negative relationship was found between PBS score and BAMBI total score in children with ASD (p<0,05). Moderate positive relationships were found between JTHFT 'small objects' sub-parameter value and STEP 'total' frequency x severity; JTHFT 'feeding simulation' sub-parameter value and STEP 'feeding skills deficits' frequency, frequency x severity, and 'food refusal' frequency x severity scores (p<0,05). Regarding sensory processing, the total score of the Sensory Profile Scale's processing section showed a negative high-level relationship with STEP 'total' frequency, frequency x severity, and STEP 'skill deficiency' frequency scores. It also showed a negative moderate-level relationship with STEP 'aspiration risk,' 'food selection,' 'food refusal,' 'food behavior problem' sub-group frequency, frequency x severity scores, and 'skill deficiency' frequency x severity score, as well as BAMBI total score (p<0,05). The total score of the Sensory Profile Scale's modulation section showed a negative moderate-level relationship with STEP 'food behavior problem' frequency, frequency x severity scores, excluding STEP total and other sub-group frequencies, frequency x severity, and BAMBI total scores (p<0,05). The total score of the Sensory Profile Scale's behavior and emotional responses section showed a negative moderate-level relationship with STEP 'total' and all sub-group frequencies, frequency x severity, and BAMBI total scores (p<0,05). The total score of the Sensory Profile Scale showed a negative high-level relationship with STEP 'food selection,' 'skill deficiency,' and 'total' sub-group frequencies, frequency x severity scores. It also showed a negative moderate-level relationship with STEP 'aspiration risk,' 'food refusal,' 'food behavior problem' sub-group frequencies, frequency x severity scores, and BAMBI total scores (p<0,05). In conclusion, this study revealed that posture, hand functions, sensory processing skills, nutrition, and quality of life are negatively affected in children with ASD. Associations were found between hand functions, sensory processing skills, quality of life, and nutrition. Evaluating children with ASD in terms of these parameters at an early stage and supporting them with physiotherapy and rehabilitation programs may be beneficial for both the children and their parents. Keywords: Autism Spectrum Disorder, posture, sensory processing, hand functions, nutrition