Author: Samruddhi Damle (UMCG)

The following REPAIRS toolbox is available under the CC-BY licence (Creative- Commons:  https://creativecommons.org/). This implies that others are free to share and adapt our works under the condition that appropriate credit to the original contribution (provide the name of the REPAIRS consortium and the name the authors of the toolbox when available, and a link to the original material) is given and indicate if changes were made to the original work. 

Objective

This toolbox aims to increase awareness of an alternative to the traditional view: a systems-perspective and ecological approach to understanding autism spectrum disorder (ASD) and its rehabilitation. It is designed for the scientific community, practitioners, therapists and clinical researchers who seek more comprehensive frameworks for understanding the dynamic interplay of motor, perceptual, and social systems in ASD. Moving beyond reductionist models, this approach emphasizes the foundational role of the environment, perception–action coupling, affordances and prospective motor control in delineating rehabilitation of ASD.

Shifting the Perspective: From Reductionism to an Ecological Perspective

Traditional approaches to ASD have largely been grounded in reductionist models, which frame autism in terms of discrete deficits, particularly in social behavior, language and repetitive patterns. Rehabilitation within this framework tends to focus on behavior modification, most notably through Applied Behavior Analysis (ABA), targeting observable symptoms and aiming to normalize outward behaviors (Roane et al., 2016). For example, if a child with ASD avoids eye contact, an ABA approach might focus on training the child to make eye contact by using prompts and rewards to reinforce temporary compliance. While this can produce short-term behavioral gains and “fix” the symptoms, it often overlooks the context and underlying perceptual, motor or sensory factors driving the behavior. In contrast, the ecological approach focuses on enriching the environment to invite interaction (e.g., using large movement games, virtual games or sensory-friendly materials). Such invitations would lead to the emergence of social engagement through interaction, rather than prescription.

Ecological and systems-based approaches offer an alternative to reductionist models by viewing autism as a condition emerging from disrupted interactions across multiple levels of functioning – neurological, motor, cognitive, and social – and shaped by the individual’s relationship with their environment. Rehabilitation within this framework focuses not on correcting isolated behaviors, but on restoring functional perception-action couplings through enriched interaction with the environment. Rather than attempting to “correct” behavior, the ecological approach aims to support individuals in regaining access to the informational structure of their environments, enabling more functional perception-action couplings.

Theoretical Foundations: Affordances, Direct Perception, and Prospective Control

At the center of this systems-perspective is the ecological psychology, particularly Gibson’s theory of direct perception, which asserts that individuals perceive affordances – possibilities for action – directly from the environment (Gibson, 1979/1986; Fajen 2007). Affordances are specific to each individual’s action capabilities, and their successful perception requires picking up or attuning to the relevant information variables. A hypothesis of this perspective pertains to individuals with ASD exhibiting difficulties in perceiving and acting upon such affordances, particularly in dynamic, socially demanding contexts.

Prospective control, the ability to guide current actions based on prospective future outcomes, is often disrupted in individuals with ASD (Sheppard et al., 2016; Cannon et al., 2021). This impairment can be observed in social coordination, motor coordination, fine and gross motor actions, and joint action, where timing and prediction are essential (Licari et al., 2020; Kangarani-Farahani et al., 2024; Balsters et al., 2017). For instance, individuals with ASD tend to have difficulty timing their movements to match others during activities like catching a ball or taking conversational turns, contexts that require anticipating the unfolding dynamics of others’ actions. Importantly, such online control and coordination requires tight coupling between perception-action systems to allow for on-the-fly adjustments. The ecological approach posits that individuals with ASD may perhaps struggle to access the information structure (spatial and temporal) of their environments in ways that support affordance perception and actualization.

The Constraints-Led Approach (CLA) complements this model by focusing on how behavior is shaped by the interaction of individual, task, and environmental constraints. This non-prescriptive approach encourages exploration and adaptation, promoting self-organization rather than repetition or imitation. By manipulating task features-such as focus of attention, complexity, social load, timing or spacial layout- therapists can design conditions that foster perceptual attunement and learning of affordance behavior.

For therapists, adopting an ecological approach would mean shifting from prescribing behavior toward designing environments that invite meaningful engagement. Rather than teaching specific social or motor skills in isolation, the therapist’s role is to manipulate constraints, such as space, timing or task demands, to support self-organization and perceptual attunement. For example, instead of telling a child to “take turns”, a therapist might introduce a cooperative ball game where turn-taking emerges naturally through shared rhythm, visual or musical cues. This approach emphasizes creating conditions for behavior to emerge, rather than directing or correcting it.

Rehabilitation as Relearning Informational Cues

This ecological perspective reconceptualizes rehabilitation not as behavioral compliance training but as relearning the informational cues necessary for functional interaction. In ASD, the perception of motor cues (e.g., movement kinematics, proprioception), social cues (e.g., gaze, posture, proximity), and broader environmental structure (e.g., specifying information variables) might often be disrupted (Riddiford et al., 2022; Cook et al., 2013; Whyatt & Craig, 2013). These disruptions hinder the emergence of coordinated and meaningful actions.

Rehabilitation techniques might benefit from targeting perceptual learning, the process by which individuals become attuned t oinvariant infomration within dynamin environments. This requires exposure to varied, ecologically valid situations where individuals can explore, receive feedback and gradually recalibrate their perceptual systems. For example, rather than the traditional approach of giving explicit instructions to a child to “look at the ball on the screen and catch it”, ecological interventions might involve information-based games that develop the underlying sensitiivty necessary for coordinating a cathing action. For instance, providing gamified cues that guide the catching behavior might help individuals to learn better (example: visually highlighting the ball’s trajectory). Thus, by shifting focus from explicit instruction to guided exploration, therapists can facilitate the development of perceptual learning in individuals with ASD.

Further, individuals with ASD can be guided to develop affordance-based control strategies, the ability to perceive and actualize action possibilities in real time. Such control is foundational for social interaction and coordinated actions and may be more developmentally appropriate and transferable than traditionally used prescriptive teaching methods. Use of gamification tools like singles or doubles pong (see Toolbox on Doubles Pong) might be a starting point for first acquiring a baseline of kinematic performance, and then subsequently serve to develop affordance-based interventions and manipulations. The concept can be extended to affordance perception and actualization not only for the self, but also for another or several others through the doubles pong paradigm.

Implications for Diagnosis and Research

This paradigm shift has important diagnostic implications. Standard assessments of ASD often rely on behavioral observation and caregiver reports, which may miss subtle but meaningful disruptions in motor and perceptual behavior. This is particularly true in populations who compensate through masking or social imitation (e.g., females with ASD). Incorporating motor diagnostics, such as kinematic analysis, joint action tasks, and affordance-based performance measures, can reveal early signs of atypical development that are not accessible through traditional tools and do not lend themselves to masking.

Moreover, advanced mixed modeling of affordances holds potential for advancing both diagnosis and personalized intervention by incorporating individual differences rather than averaging techniques. Machine learning algorithms trained on movement data might help identify atypical coordination patterns, movement signatures and generate adaptive task designs in real time. Future research should prioritize the development of ecologically valid assessment tasks and longitudinal studies that track how perceptual learning and affordance-based interventions influence ASD symptoms over time. Further emphasis should be placed on agent-environment coupling, affordance-based control and the individualization of interventions.

Conclusion

A systems perspective and ecological approach to ASD offers a scientifically motivated, functionally relevant alternative to traditional behaviorist models. By centering intervention on the principles of affordances, ecological information and prospective control, this perspective promotes learning through engagement with the environment. Rehabilitation becomes a process of restoring access to the informational structures that support coordinated, functional behavior. For the scientific and diagnostic communities, this approach opens new avenues for research, assessment, and practice, while aligning intervention more closely with the embodied, embedded and ecological approaches to human behavior.

References

Cannon, J., O’Brien, A. M., Bungert, L., & Sinha, P. (2021). Prediction in autism spectrum disorder: A systematic review of empirical evidence. Autism research, 14(4), 604-630.

Sheppard, E., van Loon, E., Underwood, G., & Ropar, D. (2016). Difficulties predicting time-to-arrival in individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 28, 17-23.

Balsters, J. H., Apps, M. A., Bolis, D., Lehner, R., Gallagher, L., & Wenderoth, N. (2017). Disrupted prediction errors index social deficits in autism spectrum disorder. Brain, 140(1), 235-246.

Licari, M. K., Alvares, G. A., Varcin, K., Evans, K. L., Cleary, D., Reid, S. L., … & Whitehouse, A. J. (2020). Prevalence of motor difficulties in autism spectrum disorder: Analysis of a population‐based cohort. Autism Research, 13(2), 298-306.

Kangarani-Farahani, M., Malik, M. A., & Zwicker, J. G. (2024). Motor impairments in children with autism spectrum disorder: A systematic review and meta-analysis. Journal of autism and developmental disorders, 54(5), 1977-1997.

Roane, H. S., Fisher, W. W., & Carr, J. E. (2016). Applied behavior analysis as treatment for autism spectrum disorder. The Journal of pediatrics, 175, 27-32.

Whyatt, C., & Craig, C. (2013). Sensory-motor problems in Autism. Frontiers in integrative neuroscience, 7, 51.

Cook, J. L., Blakemore, S. J., & Press, C. (2013). Atypical basic movement kinematics in autism spectrum conditions. Brain, 136(9), 2816-2824.

Riddiford, J. A., Enticott, P. G., Lavale, A., & Gurvich, C. (2022). Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta‐analysis. Autism Research, 15(8), 1380-1446.

Gibson, J. J. (1979/1986). The ecological approach to visual perception. Houghton-Mifflin, Boston.

Fajen, B. R. (2007). Affordance-based control of visually guided action. Ecological Psychology, 19(4), 383-410.