Otizm Spektrum Bozukluğu Olan Çocuklarda Vestibüler Fonksiyonların Objektif Değerlendirilmesi: Sistematik Bir Derleme

Abstract

Otizm Spektrum Bozukluğu olan çocuklarda vestibüler, propriyoseptif, taktil, görsel ve işitsel duyusal işlemleme bozuklukları sıklıkla görülmekte ve bu durum günlük yaşam aktivitelerini olumsuz etkileyebilmektedir. Vestibüler sistemden gelen duyusal bilgi; denge, göz hareketleri, postüral kontrol ve uzaysal farkındalık için kritik öneme sahiptir. Bu sistematik derleme, otizm spektrum bozukluğu tanılı çocuklarda vestibüler fonksiyonların objektif ölçüm yöntemleriyle değerlendirildiği 2000–2025 yılları arasındaki çalışmaları kapsamlı bir şekilde incelemeyi amaçlamaktadır. PRISMA yönergelerine uygun olarak Web of Science ve PubMed veri tabanları “autism”, “vestibular” ve “children” anahtar kelimeleri kullanılarak taranmış, belirtilen yıllar arasında yayımlanan ve vestibüler fonksiyonları objektif yöntemlerle değerlendiren İngilizce çalışmalar dahil edilmiştir. Seçilen çalışmalar iki bağımsız araştırmacı tarafından değerlendirilmiş ve metodolojik kalite Newcastle-Ottawa Ölçeği kullanılarak incelenmiştir. Bulgular, otizm spektrum bozukluğu olan çocukların vestibüler sistem işlevselliğinde bazı alanlarda tipik gelişim gösteren akranlarıyla benzerlikler sergilerken, diğer alanlarda belirgin farklılıklar gösterdiğini ortaya koymuştur. Rotasyonel vestibülo-oküler refleks testlerinde çelişkili sonuçlar bildirilmiş; bazı çalışmalarda refleks kazancında artış ve düzensiz göz hareketleri gözlemlenirken, bazılarında anlamlı farklılık saptanmamıştır. Video head impulse testleri yüksek frekanslı yarım daire kanalı fonksiyonunun çoğunlukla korunduğunu gösterirken, fonksiyonel head impulse testleri vestibülo-oküler refleks fonksiyonunda bozulmaya işaret etmiştir. Vestibüler uyarılmış miyojenik potansiyel testleri otolit fonksiyonları açısından tutarsız sonuçlar sunmuştur. Göz hareketi değerlendirmelerinde sakkadik latansın arttığı, denge ve postüral kontrol değerlendirmelerinde ise özellikle görsel ipuçları ortadan kaldırıldığında postüral kontrol güçlüklerinin belirginleştiği bildirilmiştir. Sonuç olarak, otizm spektrum bozukluğunda vestibüler fonksiyonlar heterojen bir doğa sergilemekte olup, bu farklılıklar otizm spektrum bozukluğunun alt gruplarındaki değişkenliklerle ilişkili olabilir. Vestibüler değerlendirme ve müdahale uygulamaları, otizm spektrum bozukluğu olan çocuklarda denge, motor planlama, koordinasyon ve duyusal modülasyon becerilerinin desteklenmesinde umut vaat eden bir alan olarak görülmektedir. Vestibüler sistemin objektif değerlendirilmesi, otizm spektrum bozukluğunun patofizyolojisinin daha iyi anlaşılmasına, erken tanı biyobelirteçlerinin geliştirilmesine ve kanıta dayalı tedavi yaklaşımlarının oluşturulmasına katkı sağlama potansiyeline sahiptir.

Keywords

• Denge
• otizm spektrum bozukluğu
• postüral kontrol
• vestibüler fonksiyon

Objective Assessment of Vestibular Functions in Children with Autism Spectrum Disorder: A Systematic Review

Abstract

Sensory processing difficulties involving vestibular, proprioceptive, tactile, visual, and auditory modalities are frequently observed in children with Autism Spectrum Disorder (ASD) and can adversely affect daily living activities. Sensory input from the vestibular system is critical for balance, eye movements, postural control, and spatial awareness. This systematic review aims to comprehensively examine studies published between 2000 and 2025 that objectively assessed vestibular functions in children with ASD. In accordance with PRISMA guidelines, the Web of Science and PubMed databases were systematically searched using the keywords “autism,” “vestibular,” and “children,” including English-language studies that evaluated vestibular function with objective measures. Selected studies were independently assessed by two researchers, and methodological quality was appraised using the Newcastle-Ottawa Scale. The findings indicate that children with ASD exhibit similarities to typically developing peers in some areas of vestibular functioning, while demonstrating notable differences in others. Rotational vestibulo-ocular reflex (VOR) tests yielded inconsistent results, with some studies reporting increased reflex gain and irregular eye movements, whereas others found no significant differences. Video head impulse tests (vHIT) generally indicated preserved high-frequency semicircular canal function, whereas functional head impulse tests (fHIT) suggested impairments in VOR function. Vestibular evoked myogenic potentials (VEMPs) produced inconsistent outcomes regarding otolith function. Eye movement assessments revealed prolonged saccadic latency, and balance and postural control evaluations demonstrated pronounced difficulties, particularly when visual cues were removed. In conclusion, vestibular functions in ASD present a heterogeneous profile, which may be associated with variability across ASD subgroups. Vestibular assessment and intervention hold promise for supporting balance, motor planning, coordination, and sensory modulation skills in children with ASD. Objective evaluation of the vestibular system has the potential to advance understanding of ASD pathophysiology, facilitate the development of early diagnostic biomarkers, and inform evidence-based therapeutic approaches.

Keywords

• Balance
• autism spectrum disorder
• postural control
• vestibular function

References

1. Abdel Ghafar, M. A., Abdelraouf, O. R., Abdelgalil, A. A., Seyam, M. K., Radwan, R. E., & El-Bagalaty, A. E. (2022). Quantitative assessment of sensory integration and balance in children with autism spectrum disorders: Cross-sectional study. Children, 9(3), 353. https://doi.org/10.3390/children9030353
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) [Ruhsal bozuklukların tanısal ve sayısal el kitabı (5. baskı)]. https://doi.org/10.1176/appi.books.9780890425596
3. Caldani, S., Baghdadi, M., Moscoso, A., Acquaviva, E., Gerard, C.-L., Marcelli, V., Peyre, H., Atzori, P., Delorme, R., & Bucci, M. P. (2020). Vestibular functioning in children with neurodevelopmental disorders using the functional head impulse test. Brain Sciences, 10(11), 887. https://doi.org/10.3390/brainsci10110887
4. Carson, T. B., Wilkes, B. J., Patel, K., Pineda, J. L., Ko, J. H., Newell, K. M., Bodfish, J. W., Schubert, M. C., Radonovich, K., White, K. D., & Lewis, M. H. (2017). Vestibulo-ocular reflex function in children with high-functioning autism spectrum disorders. Autism Research, 10(2), 251-266. https://doi.org/10.1002/aur.1642
5. Chisari, D., Vitkovic, J., Clark, R., & Rance, G. (2024). Vestibular function and postural control in children with autism spectrum disorder. Journal of Clinical Medicine, 13(17), 5323. https://doi.org/10.3390/jcm13175323
6. Cullen K. E. (2012). The vestibular system: multimodal integration and encoding of self-motion for motor control. Trends in Neurosciences, 35(3), 185-196. https://doi.org/10.1016/j.tins.2011.12.001
7. Deng, J., Lei, T., & Du, X. (2023). Effects of sensory integration training on balance function and executive function in children with autism spectrum disorder: Evidence from Footscan and fNIRS. Frontiers in Psychology, 14, 1269462. https://doi.org/10.3389/fpsyg.2023.1269462
8. Ferrè, E. R., Walther, L. E., & Haggard, P. (2015). Multisensory interactions between vestibular, visual and somatosensory signals. PLoS ONE, 10(4), e0124573. https://doi.org/10.1371/journal.pone.0124573

9. Ferreiro-Pérez, M., Abuín-Porras, V., Martín-Casas, P., & Ortiz-Gutiérrez, R. M. (2024). Postural control and sensory processing in preschool children with autistic spectrum disorder: A cross-sectional study. Children, 11(3), 303. https://doi.org/10.3390/children11030303
10. Furman, J. M., Osorio, M. J., & Minshew, N. J. (2015). Visual and vestibular induced eye movements in verbal children and adults with autism. Autism Research, 8(6), 658–667. https://doi.org/10.1002/aur.1481
11. Goldberg, M. C., Landa, R., Lasker, A., Cooper, L., & Zee, D. S. (2000). Evidence of normal cerebellar control of the vestibulo- ocular reflex (VOR) in children with high-functioning autism. Journal of Autism and Developmental Disorders, 30(6), 519- 524. https://doi.org/10.1023/a:1005800717411
12. Johnson, B. P., Lum, J. A. G., Rinehart, N. J., & Fielding, J. (2016). Ocular motor disturbances in autism spectrum disorders: Systematic review and comprehensive meta-analysis. Neuroscience and Biobehavioral Reviews, 69, 260-279. https://doi.org/10.1016/j.neubiorev.2016.08.007
13. Kern, J. K., Trivedi, M. H., Grannemann, B. D., Garver, C. R., Johnson, D. G., Andrews, A. A., Savla, J. S., Mehta, J. A., & Schroeder, J. L. (2007). Sensory correlations in autism. Autism, 11(2), 123-134. https://doi.org/10.1177/1362361307075702
14. Lane, A. E., Young, R. L., Baker, A. E. Z., & Angley, M. T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism and Developmental Disorders, 40(1), 112-122. https://doi.org/10.1007/s10803-009- 0840-2
15. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2007). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37(5), 894–910. https://doi.org/10.1007/s10803-006-0218-7
16. Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., Taylor, J. L., & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. Nature Reviews Disease Primers, 6(1), 5. https://doi.org/10.1038/s41572-019-0138-4
17. Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L. C., Harrington, R. A., Huston, M., ... Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8 years-Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016. MMWR Surveillance Summaries, 69(4), 1-12. https://doi.org/10.15585/mmwr.ss6904a1
18. Ornitz, E. M., Atwell, C. W., Kaplan, A. R., & Westlake, J. R. (1985). Brain-stem dysfunction in autism: Results of vestibular stimulation. Archives of General Psychiatry, 42(10), 1018-1025. https://doi.org/10.1001/archpsyc.1985.01790330102012
19. Oster, L. M., & Zhou, G. (2022). Balance and vestibular deficits in pediatric patients with autism spectrum disorder: An underappreciated clinical aspect. Autism Research and Treatment, 2022, 7568572. https://doi.org/10.1155/2022/7568572
20. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
21. Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671-684. https://doi.org/10.1038/nrn.2017.112
22. Shayman, C. S., Seo, J.-H., Oh, Y., Lewis, R. F., Peterka, R. J., & Hullar, T. E. (2018). Relationship between vestibular sensitivity and multisensory temporal integration. Journal of Neurophysiology, 120(4), 1572–1577. https://doi.org/10.1152/jn.00379.2018
23. Smoot Reinert, S., Jackson, K., & Bigelow, K. (2014). Using posturography to examine the immediate effects of vestibular therapy for children with autism spectrum disorders: A feasibility study. Physical & Occupational Therapy in Pediatrics, 34(4), 365- 380. https://doi.org/10.3109/01942638.2014.975313
24. Strupp, M., Kim, J. S., Murofushi, T., Straumann, D., Jen, J. C., Rosengren, S. M., Della Santina, C. C., & Kingma, H. (2017). Bilateral vestibulopathy: Diagnostic criteria consensus document of the Classification Committee of the Bárány Society. Journal of Vestibular Research, 27(4), 177-189. https://doi.org/10.3233/VES-170619
25. Thabet, E. M. (2014). Ocular vestibular evoked myogenic potentials N10 response in autism spectrum disorders children with auditory hypersensitivity: An indicator of semicircular canal dehiscence. European Archives of Otorhinolaryngology, 271(7), 1283- 1288. https://doi.org/10.1007/s00405-013-2736-1
26. Van Hecke, R., Deconinck, F. J. A., Van Acker, E., Danneels, M., Dhooge, I., Van Waelvelde, H., Wiersema, J. R., & Maes, L. (2025). Vestibular function in children with neurodevelopmental disorders: A neglected sense? Clinical Neurophysiology, 171, 1-10. https://doi.org/10.1016/j.clinph.2024.12.026
27. Valente, L. M. (2011). Assessment techniques for vestibular evaluation in pediatric patients. Otolaryngologic Clinics of North America, 44(2), 273–290. https://doi.org/10.1016/j.otc.2011.01.002
28. Valverde-Esteve, T., Salvador-Garcia, C., Gil-Gómez, J., & Maravé-Vivas, M. (2021). Sustainable service-learning in physical education teacher education: Examining postural control to promote ASD children's well-being. International Journal of Environmental Research and Public Health, 18(10), 5216. https://doi.org/10.3390/ijerph18105216
29. Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism Research, 15(5), 778-790. https://doi.org/10.1002/aur.2696