The Use of Visual Imagery in Asperger’s Syndrome

1. Abstract The Use of Visual Imagery in Asperger’s Syndrome Patricia Precin, M.S., OTR/L, Diana S. Chang, M.S.O.T., Charles Jean-Paul, M.S.O.T., Michele Floria, M.S., OTR/L, January Magno, M.S., OTR/L, & Simi Thomas, M.S., OTR/L. New York Institute of Technology Objective This pilot study investigated the use of visual imagery in the performance of daily activities in three individuals with Asperger’s Syndrome. Method The Short Imaginal Process Inventory (Huba et al.1982) was used to determine subjects’ innate ability to image and The Revised Kitchen Task Assessment (Baum et al. 2003) was used to measure performance on a hand washing and simple cooking task before and after the use of visual imagery. Results A positive relationship appears to exist between the use of visual imagery and improved performance on a hand washing task as per visual inspection of the data. A positive outcome was found between the use of visual imagery in improving performance on a simple cooking task, more specifically, the execution/motor planning of the task as per visual inspection of the data. There did not seem to be a relationship between innate ability to image and performance. Conclusion The use of visual imagery may increase the ability of individuals with Asperger’s Syndrome to perform more independently on a daily activity regardless of their innate ability to image. Results Introduction Methods Table 2 Descriptive statistics of the KTA before and after the use of visual imagery Hand washing Hand washing Cooking Cooking Participant pre-test post-test pre-test post-test component #1 Initiation 2 0 1 0 Organization 2 0 1 0 Sequencing 0 0 3 1 Judgment & Safety 0 0 4 1 Completion 0 0 1 0 Total 4 0 10 2 #2 Initiation 0 0 0 0 Organization 3 0 1 1 Sequencing 1 0 1 1 Judgment & Safety 0 0 1 1 Completion 1 0 0 0 Total 5 0 3 3 #3 Initiation 1 0 1 2 Organization 1 0 3 2 Sequencing 1 0 3 2 Judgment & Safety 1 0 3 3 Completion 1 0 3 2 Total 5 0 13 11 Note. Numbers indicate scores on specified neurobehavioral components of the KTA. 0 = independence; 1 = verbal guidance; 2 = gestural guidance; 3 = verbal direct instruction; 4 = physical assistance; 5 = do for subject. Pervasive Developmental Disorders consist of a constellation of innate conditions characterized by marked social impairment, communication difficulties, play deficits, and a range of repetitive behaviors or interests (Klin, 2003). Asperger’s Syndrome (AS) falls within the category of Pervasive Developmental Disorders (PDD) (DSM IV; American Psychiatric Association, 1994). Presenting problems of AS often include inattention, impulsivity, motor and sensory difficulties, learning disorders, cognitive impairments, oppositional behavior and obsessive-compulsive disorder, usually marked by eccentric preoccupations (Perry, 2004). These clinical manifestations often result in problems in independent participation in meaningful occupations such as activities of daily living (ADL). Occupational therapists have used a variety of interventions to increase ADL skills in people diagnosed with AS, but an extensive review of the literature did not include studies that utilized visual imagery, the act of imagining the exact replication of how a task is performed in order to enhance performance. However, one study conducted by Ring et al. (1999) who, through the use of a functional MRI study of embedded figure task performance, suggests that individuals with AS may have some capabilities in the use of visual imagery. Since individuals with AS may have difficulty with the sequencing, execution, and organization of tasks, due in part to executive functioning difficulties, and visual imagery attempts to help individuals perform sequential tasks in the correct order in an organized, pre-determined fashion, occupational therapists may choose to incorporate visual imagery into their intervention programs for people diagnosed with AS to aid in the learning and execution of ADLs. The hypothesis of this study is that the use of visual imagery in individuals with AS, who are participating in a vocational program in the northeast US, will be associated with improvements in level of independence while performing activities of daily living. A second hypothesis is that participants, who have a strong innate ability to create positive images, as measured by the Short Imaginal Process Inventory, will show the greatest improvement in ADL performance. • Three adolescents (2 male and 1 female) with AS ranging in age from 21-22 years old were recruited from the Vocational Independence Program (VIP), located in the northeast US, to participate in this study. All participants were selected on the basis of the following inclusionary criteria: students of the VIP, a diagnosis of AS, the need for ADL assistance as pre-determined by the VIP, and parental consent for release of their results of this study. Those with additional DSMV-TR diagnoses on Axis I or II were excluded. • Short Imaginal Process Inventory (SIPI) • A brief instrument that measures aspects of daydreaming, contact and style, mental style, and general inner experience through a 45 item self-report questionnaire. • Kitchen Task Assessment (KTA) • A functional assessment that measures the cognitive function necessary for preparing a simple cooking task. • The experiments were conducted using eight sessions at the VIP. • Day 1: Short Imaginal Processes Inventory was administered to measure the subjects’ innate ability to image. • Day 2: Baseline measurements were gathered using the KTA to assess the subjects’ ability to complete a kitchen task. • Day 3-6: The subjects were exposed to a series of visual images of an individual performing a simple kitchen task. • Day 7: The subjects’ ability to complete the same task was measured again using the KTA. • Day 8: The participants and the students investigators terminated by watched a recreational movie together. • Data Analysis • Descriptive statistics of the SIPI were calculated using the Statistical Package for the Social Sciences (SPSS) (Table 1) to determine T-scores. Descriptive data of the KTA before and after the use of visual imagery were recorded (Table 2) using raw data for each participant. Table 1 describes the participants’ scores on the SIPI using the T-score, which is the normalized score (the distribution is ‘forced’ to be the normal one) with a mean of 50 and standard deviation of 10. Table 2 shows descriptive statistics on pre- and post-tests for hand washing and simple cooking. Table 2 indicates an overall improvement in hand washing ability after imaging. The first participant improved in two components: initiation and organization. The second participant improved in three components: organization, sequencing, and completion. And, the third participant improved in all five component areas: initiation, organization, sequencing, judgment, and completion. The first participant’s overall score improved from a four to a zero and the second and third participants’ overall scores improved from a five to a zero. Initially, all participants required guidance during this task, including verbal guidance, gestural guidance or verbal direct guidance. After four sessions of imagery, all of the participants were able to perform this task independently after being asked to wash their hands. These results indicate that the use of visual imagery may have contributed to a more independent performance. Table 1 T-Score from Short Imaginal Process Inventory Participant(s) Positive-Constructive Guilt Poor Attentional Daydreaming Fear-of-Failure Control Participant 1 54 62 63 Participant 2 60 48 51 Participant 3 66 61 53 ( ( This research has been partially funded by a grant from the Metropolitan New York District of the New York State Occupational Therapy Association. Conclusion References Comparison of the participant scores of the SIPI and KTA suggested that for these particular individuals, the SIPI is not a good indicator of the participants’ ability to use visual imagery to enhance the performance of an ADL. Therefore, innate ability to image may not be associated with the ability to use visual imagery to perform more independently in ADL. Perhaps providing visual cues (sequences photos of preparing oatmeal) to help participants form their own visual images in the task of making oatmeal was helpful in teaching visual imagery whether or not the participants had this ability before they began the study. The overall improvement noted in hand washing ability and the improvements seen in two of the participants in preparing oatmeal after imaging support the research of Ring et al. (1999), that individuals with AS have some capabilities in the use of visual imagery. These results indicate that the use of visual imagery may have contributed to a more independent performance through improving task initiation, organization, sequencing, judgment and safety and completion. These findings provide implications for the continuing education of occupational therapists in increasing their knowledge of visual imagery techniques in helping individuals with AS increase their skills and engagement in everyday occupation. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Baum, M. C., Edwards, D. Hahn, M., & Morrison, T. (2003).Revised Kitchen Task Assessment (KTA). Unpublished manuscript, Washington University School of Medicine, St. Louis, MO. Huba, G. J., Singer, J. L., Aneshensel, C. S., Antrobus, J. S. (1982). The Short Imaginal Processes Inventory. Port Huron, MI: Research Psychologists Press. Klin, A. (2003). Asperger Syndrome: An update. 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