ASDNCT07851272
Internal Versus External Attentional Focus in Gross- and Fine-Motor Learning Among Children With Autism Requiring Ongoing Everyday Support
A study testing External Focus of Attention Instructions and Internal Focus of Attention Instructions in people with ASD, run by University of Haifa at 1 site in Israel.
Trial 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… Read more about this study
- Who is it for?
- Ages 7 to 14 years
- Conditions the study is for
- ASD
- What is being tested?
- External Focus of Attention Instructions and Internal Focus of Attention Instructions
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 10 participants
- Where
- 1 siteIsrael
- Study dates
- 21 Sep 2023to 11 Aug 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 7 to 14 years
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- 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.
Who cannot join
- Co-occurring motor conditions such as cerebral palsy or developmental coordination disorder (DCD).
- Significant visual impairment. Significant hearing impairment.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Internal Versus External Attentional Focus in Gross- and Fine-Motor Learning Among Children With Autism Requiring Ongoing Everyday Support: An Exploratory Randomized Study
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.
Read the detailed description
Previous studies of motor learning have suggested that the direction of attentional focus may influence motor performance and learning. An external focus directs attention toward the effect or outcome of the movement, whereas an internal focus directs attention toward the movement of the body itself. Although external focus instructions have often been associated with better motor learning in typically developing populations, findings among children with autism spectrum disorder (ASD) have been limited and inconsistent. In addition, previous studies in children with ASD have primarily examined gross motor tasks, with little attention to fine motor learning or to individual sensory and cognitive characteristics that may influence learning.
The present randomized controlled study was designed to compare motor learning under external versus internal attentional focus instructions in children with ASD. Participants practiced both a gross motor task (basketball shooting) and a fine motor task (digital maze tracing) during three individual training sessions. The type of attentional focus instruction differed between the two study groups, while the practice structure was otherwise similar. Assessments were conducted before training, after completion of the training period, and at follow-up in order to examine changes in motor performance and learning. Transfer was also examined using modified versions of the practiced tasks. In addition, sensory processing and selected cognitive functions were assessed to explore whether individual characteristics were associated with changes in motor learning.
Cognitive and sensory characteristics were assessed for participant characterization. Cognitive functioning was assessed using selected tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB), including the Motor Screening Task (MOT), Reaction Time task (RTI), and Spatial Working Memory task (SWM). Sensory processing was assessed using the parent-reported Sensory Profile.
- Conditions
- ASD
- Being tested
- External Focus of Attention Instructions, Internal Focus of Attention Instructions
- Keywords
- Autism Spectrum Disorder, Motor Learning, Attentional Focus, External Focus of Attention, Internal Focus of Attention, Gross Motor Skills
- Medical subject headings
- Autism Spectrum Disorder
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
External Focus of Attention InstructionsBehavioural
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.
Internal Focus of Attention InstructionsBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| 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. Receives: 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. Receives: Behavioral: Internal Focus of Attention Instructions |
What is being measured
The primary outcome is the main question the study is designed to answer.
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…
Measured: 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.
Measured: 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…
Measured: 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.
Measured: 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.
Measured: 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.
Measured: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Oct 2026
- Study start21 Sep 2023
- Primary completion20 Apr 2025
- Study completion11 Aug 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for ASDStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- 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.
- Masking
- None (open label)
- Enrolment
- 10 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Haifa
- Sponsor type
- University, hospital or other
- Collaborators
- Ministry of Education, Israel
- Responsible party
- Principal investigator, Galit Yogev-Seligmann, University of Haifa
- Investigators
- Galit YOGEV Yogev-Seligmann, PhD, Principal investigator, University of HaifaLiron Lamash, PhD, Principal investigator, University of Haifa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07851272
- Sponsor's protocol ID
- 335/23
- Status last verified
- Sep 2026
- First submitted
- 24 Sep 2026
- Last updated
- 1 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified individual participant data underlying the results reported in the study may be shared upon reasonable request. These data may include study-group assignment, motor-performance outcomes at PRE, POST, and delayed retention, and participant-characterization measures from the CANTAB and Sensory Profile. No direct identifiers or other information that could reasonably permit identification of individual participants will be shared. Data sharing will be subject to ethical, consent, and privacy considerations.
Study at a glance
From the registry record, last updated by the sponsor on 1 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Internal Versus External Attentional Focus in Gross- and Fine-Motor Learning Among Children With Autism Requiring Ongoing Everyday Support: An Exploratory Randomized Study
- ClinicalTrials.gov ID
- NCT07851272
- Acronym / sponsor ID
- 335/23
- Conditions
- ASD
- Keywords
- Autism Spectrum Disorder, Motor Learning, Attentional Focus, External Focus of Attention, Internal Focus of Attention, Gross Motor Skills
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 10 participants (actual)
- Lead sponsor
- University of HaifaUniversity, hospital or other
- Collaborators
- Ministry of Education, Israel
- Study start
- 21 Sep 2023 (actual)
- Primary completion
- 20 Apr 2025 (actual)
- Study completion
- 11 Aug 2025 (actual)
- First posted
- 1 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
Previous studies of motor learning have suggested that the direction of attentional focus may influence motor performance and learning. An external focus directs attention toward the effect or outcome of the movement, whereas an internal focus directs attention toward the movement of the body itself. Although external focus instructions have often been associated with better motor learning in typically developing populations, findings among children with autism spectrum disorder (ASD) have been limited and inconsistent. In addition, previous studies in children with ASD have primarily examined gross motor tasks, with little attention to fine motor learning or to individual sensory and cognitive characteristics that may influence learning.
The present randomized controlled study was designed to compare motor learning under external versus internal attentional focus instructions in children with ASD. Participants practiced both a gross motor task (basketball shooting) and a fine motor task (digital maze tracing) during three individual training sessions. The type of attentional focus instruction differed between the two study groups, while the practice structure was otherwise similar. Assessments were conducted before training, after completion of the training period, and at follow-up in order to examine changes in motor performance and learning. Transfer was also examined using modified versions of the practiced tasks. In addition, sensory processing and selected cognitive functions were assessed to explore whether individual characteristics were associated with changes in motor learning.
Cognitive and sensory characteristics were assessed for participant characterization. Cognitive functioning was assessed using selected tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB), including the Motor Screening Task (MOT), Reaction Time task (RTI), and Spatial Working Memory task (SWM). Sensory processing was assessed using the parent-reported Sensory Profile.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- 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.
| Arm | Type | Receives |
|---|---|---|
| External Focus of Attention | Experimental | Behavioral: External Focus of Attention InstructionsParticipants 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. |
| Internal Focus of Attention | Experimental | Behavioral: Internal Focus of Attention InstructionsParticipants 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. |
Who may qualify
- Ages
- 7 to 14 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (2 listed)
- 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.
Key exclusion criteria (2 listed)
- Co-occurring motor conditions such as cerebral palsy or developmental coordination disorder (DCD).
- Significant visual impairment. Significant hearing impairment.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| External Focus of Attention InstructionsParticipants 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. | Behavioural | External Focus of Attention |
| Internal Focus of Attention InstructionsParticipants 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. | Behavioural | Internal Focus of Attention |
Primary outcome
Basketball Shooting Score
Time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
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…
Digital Maze Total Time
Time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
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.
Digital Maze Dragging Interruptions
Time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
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…
Digital Maze Total Non-Dragging Time
Time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
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.
Digital Maze Mean-Square Error (MSE)
Time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
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.
Digital Maze Maximal Error
Time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)
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.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Oct 2026.
- Individual participant dataSharing planned: Yes. De-identified individual participant data underlying the results reported in the study may be shared upon reasonable request. These data may include study-group assignment, motor-performance outcomes at PRE, POST, and delayed retention, and participant-characterization measures from the CANTAB and Sensory Profile. No direct identifiers or other information that could reasonably permit identification of individual participants will be shared. Data sharing will be subject to ethical, consent, and privacy considerations.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Galit YOGEV Yogev-Seligmann, PhD principal investigator
University of Haifa
Liron Lamash, PhD principal investigator
University of Haifa
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing External Focus of Attention Instructions and Internal Focus of Attention Instructions in people with ASD, run by University of Haifa at 1 site in Israel.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 1 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Basketball Shooting Score (time frame: Baseline (PRE), immediately after the training period (POST), and 5-8 days after the final training session (delayed retention)). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Oct 2026.