Internal Versus External Attentional Focus in Gross- and Fine-Motor Learning Among Children With Autism Requiring Ongoing Everyday Support

NCT07851272 | Completed

• 1 other identifier: 335/23
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 1

Brief Summary

This study examined how different attentional focus instructions affect motor learning in children with autism spectrum disorder (ASD). Children were randomly assigned to practice motor tasks using either external focus instructions, which directed attention toward the goal or outcome of the movement, or internal focus instructions, which directed attention toward body movements. Participants practiced both a gross motor task (basketball shooting) and a fine motor task (digital maze tracing) over three training sessions. Motor performance, retention, and transfer were assessed before and after training and at follow-up, and their relationships with sensory and cognitive characteristics were also explored.

Conditions

ASD

Keywords

Autism Spectrum Disorder; Motor Learning; Attentional Focus; External Focus of Attention; Internal Focus of Attention; Gross Motor Skills

Outcome Measures

Primary Outcomes (6)

• Basketball Shooting Score

  Basketball shooting performance was assessed over 10 trials. Each shot was scored on a four-point scale: 0 = no contact with the basket or backboard, 1 = contact with the large square on the backboard, 2 = contact with the small square or the rim, and 3 = successful basket. The mean score across the 10 trials was calculated for each assessment point, with higher scores indicating better performance. Performance was assessed at PRE, POST, and delayed retention. Immediate performance change was calculated as POST minus PRE, and retention change was calculated as delayed retention minus POST; positive change scores indicated improvement. Motor learning in ASD\_2026 WO T…

  Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)

• Digital Maze Total Time

  Total Time was defined as the duration, in seconds, from the first movement of the virtual ball until the ball reached the target during the digital maze task. For each assessment point, the mean Total Time across 10 trials was calculated. Lower values indicated better performance. Performance was assessed at PRE, POST, and delayed retention. Immediate performance change was calculated as PRE minus POST, and retention change was calculated as POST minus delayed retention; positive change scores indicated improvement.

  Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)

• Digital Maze Dragging Interruptions

  Dragging Interruptions was defined as the number of times dragging of the virtual ball was paused during performance of the digital maze task. For each assessment point, the mean number of dragging interruptions across 10 trials was calculated. Lower values indicated better performance. Performance was assessed at PRE, POST, and delayed retention. Immediate performance change was calculated as PRE minus POST, and retention change was calculated as POST minus delayed retention; positive change scores indicated improvement. Motor learning in ASD\_2026 WO T…

  Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)

• Digital Maze Total Non-Dragging Time

  Total Non-Dragging Time was defined as the cumulative duration, in seconds, during which the virtual ball was not being dragged during the digital maze task. For each assessment point, the mean Total Non-Dragging Time across 10 trials was calculated. Lower values indicated better performance. Performance was assessed at PRE, POST, and delayed retention. Immediate performance change was calculated as PRE minus POST, and retention change was calculated as POST minus delayed retention; positive change scores indicated improvement.

  Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)

• Digital Maze Mean-Square Error (MSE)

  Mean-Square Error (MSE), expressed in centimeters, was derived from the radial error at each measured point, defined as the radial distance between the participant's trajectory and the reference pre-drawn spiral. For each assessment point, the mean MSE across 10 trials was calculated. Lower values indicated better spatial accuracy. Performance was assessed at PRE, POST, and delayed retention. Immediate performance change was calculated as PRE minus POST, and retention change was calculated as POST minus delayed retention; positive change scores indicated improvement.

  Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)

• Digital Maze Maximal Error

  Maximal Error, expressed in centimeters, was defined as the largest radial deviation between the participant's trajectory and the reference spiral observed during the digital maze task. For each assessment point, the mean Maximal Error across 10 trials was calculated. Lower values indicated better spatial accuracy. Performance was assessed at PRE, POST, and delayed retention. Immediate performance change was calculated as PRE minus POST, and retention change was calculated as POST minus delayed retention; positive change scores indicated improvement.

  Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)

Study Arms (2)

External Focus of Attention

EXPERIMENTAL

Participants practiced two motor tasks: basketball shooting (gross motor task) and digital maze tracing (fine motor task) across three individual training sessions. Each session included three blocks of 10 trials for each task. Participants received external focus instructions directing attention toward the goal or outcome of the movement, such as focusing on the basket during basketball shooting and on the ball/target during the digital maze task.

Behavioral: External Focus of Attention Instructions

Internal Focus of Attention

EXPERIMENTAL

Participants practiced the same two motor tasks: basketball shooting (gross motor task) and digital maze tracing (fine motor task) across three individual training sessions. Each session included three blocks of 10 trials for each task. Participants received internal focus instructions directing attention toward their own body movements, such as focusing on hand and finger movements during the digital maze task and on arm position and movement during basketball shooting.

Behavioral: Internal Focus of Attention Instructions

Interventions

External Focus of Attention Instructions BEHAVIORAL

Participants practiced a gross motor task (basketball shooting) and a fine motor task (digital maze tracing) during three training sessions. Each session included three blocks of 10 trials for each task. External focus instructions directed the participant's attention toward the goal or outcome of the movement. For basketball shooting, participants were instructed to focus on the basket. For digital maze tracing, participants were instructed to focus on the target of the task rather than on their body movements.

External Focus of Attention

Internal Focus of Attention Instructions BEHAVIORAL

Participants practiced a gross motor task (basketball shooting) and a fine motor task (digital maze tracing) during three training sessions. Each session included three blocks of 10 trials for each task. Internal focus instructions directed the participant's attention toward their own body movements. For basketball shooting, instructions focused on the position and movement of the arms and hands. For digital maze tracing, participants were instructed to focus on the movements of their hand and fingers.

Internal Focus of Attention

Eligibility Criteria

• Age: 7 Years - 14 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Children aged 7-14 years. Current diagnosis of Autism Spectrum Disorder (ASD) established by qualified multidisciplinary professionals in accordance with Israeli Ministry of Health guidelines.
• Enrolled in a specialized educational setting for children with autism. Verbal communication ability. Independent mobility. Ability to understand simple instructions and participate in structured activities.

You may not qualify if:

• Co-occurring motor conditions such as cerebral palsy or developmental coordination disorder (DCD).
• Significant visual impairment. Significant hearing impairment.

Sponsors & Collaborators

• University of Haifa: lead
• Ministry of Education, Israel: collaborator

Study Sites (1)

Ma'ayan School

Afula, Northern District, 3780800, Israel

Location

MeSH Terms

Conditions

Autism Spectrum Disorder

Condition Hierarchy (Ancestors)

Child Development Disorders, Pervasive; Neurodevelopmental Disorders; Mental Disorders

Study Officials

• Galit YOGEV Yogev-Seligmann, PhD

  University of Haifa

  PRINCIPAL INVESTIGATOR

• Liron Lamash, PhD

  University of Haifa

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior lecturer and researcher

Model Details: Participants were randomly assigned to one of two parallel groups: an external focus of attention group or an internal focus of attention group. Each participant received the assigned attentional focus instructions throughout all training sessions.

Study Record Dates

• First Submitted: September 24, 2026
• First Posted: October 1, 2026
• Study Start: September 21, 2023
• Primary Completion: April 20, 2025
• Study Completion: August 11, 2025
• Last Updated: October 1, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will share

Locations

IL (1)