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Motor Skills in Autism: A Missed Opportunity Spectrum

Ashley from Marchena

Assistant professor, University of Sciences


Casey zampella

Scientist, Autism Research Center, Children’s Hospital of Philadelphia

Eat a delicious meal, rant with a friend, play an instrument, take on that boulder race in the middle of your favorite hike – some of life’s greatest pleasures depend on a diverse and complex set of motor skills. Despite the central role of motor function in many aspects of daily life, its link to many neurodevelopmental and mental health disorders is poorly understood. And neglecting its connection to autism has led to missed opportunities for research and clinical care.

Clinicians and scientists have described differences in motor skills since the earliest conceptualizations of autism, but these differences are widely believed to be peripheral to basic disease traits. In the Diagnostic and Statistical Manual of Mental Disorders, 5e Editing (DSM-5), for example, atypical gait and awkwardness are included only as “associated characteristics”, regardless of the primary phenotype.

As a result, autism theories, assessments, and interventions tend to obscure the extent to which differences in motor skills affect people with autism. A burgeoning literature, however, suggests that large motor differences are more relevant than what has been historically valued for understanding, assessing, and supporting people on the spectrum.

We recently reviewed the most recent research on motor skills in autism, with an emphasis on the evidence most relevant to clinical care. We concluded that differences in motor skills are a significant and significantly underutilized clinical target for people with autism of all ages. They should also be included in the DSM as a clinical specifier for autism. Such a representation would signal the need for focused attention to motor function, and it would provide a clear framework for how motor differences fit into the larger diagnostic picture.

APeople with utism and non-autism exhibit large group-level differences in various areas of motor skills, according to numerous recent reviews and meta-analyzes. Three large-scale prevalence studies also confirmed that general motor differences are pervasive, clinically significant, and under-recognized in autism. Up to 87 percent of autistic children have motor problems, but only a small number receive motor-specific diagnosis or treatment (15 percent) or treatment (32 percent), revealing a considerable clinical difference. Based on these findings, motor challenges are at least as prevalent in people with autism as cognitive or language impairments, which are both specifiers of DSM and widely considered to shape individual presentations, treatment recommendations and the results.

Given the pervasiveness of motor differences in autism, it is possible that they are not simply associated with the diagnosis, but intrinsically linked to basic autism traits. Developmentally, motor skills play a key role in shaping children’s interactions with other people and their environment from early childhood, and are therefore intrinsically linked to the development of social, communication, adaptive and cognitive skills. The first communication skills to emerge – facial expressions, joint attention, and proto-imperative pointing – are all motor behaviors. Early differences in motor behavior could therefore have cascading effects on development across domains.

Indeed, early fine and gross motor skills and simultaneous and future communication skills in young children who are ultimately diagnosed with autism. are widely associated, according to a meta-analysis. Likewise, in older children, a greater risk of motor impairment is linked to social communication skills and restricted and repetitive behaviors, suggest two recent studies of the nationally representative SPARK dataset.

Social communication cues such as eye contact, facial expressions, social orientation, and gestures all fundamentally rely on movement, and even subtle atypias in these nonverbal cues can impair their effectiveness. The overall ways in which people move their bodies (including gait, posture, and coordination) are also very important to others in everyday settings. As a result, the challenges of motor planning and execution could directly influence the social interactions and social perceptions of people with autism.

Researchers have begun to theorize that the fundamental differences in the way people with autism and non-autism move can make harder for them to connect, reflecting the “double empathy” problem. Our own recent work suggests that children and adolescents with autism are less likely than their neurotypical peers to synchronize bodily movements and facial expressions with those of neurotypical conversation partners, and that this reduced social coordination is associated with more pronounced autistic traits and less typical social and communication relationships. skills.

Of course, the impact of differences in motor skills extends far beyond social communication. Difficulty or discomfort with movement-based activities can prevent children and adults with autism from engaging in healthy, enjoyable activities such as exercise, art hobbies, or even meals. One of us (from Marchena) worked on a treatment study for selective feeding in autistic children and distinctly remembers a 10-year-old who only ate finger foods. Although it is often assumed that selective feeding is due to cognitive inflexibility or sensory aversions, this boy’s father was convinced that his son’s was largely due to his discomfort and frustration with use utensils.

Dealing with fundamental motor difficulties could help solve problems that have been misinterpreted as oppositional behavior. For example, a child with autism may actively resist preparing for school because delays in fine motor skills make everyday tasks such as tying shoes or buttoning a coat particularly difficult. Directly supporting differences in motor skills can provide a new avenue for improving functional outcomes and reducing frustration, in a variety of areas of daily life.

Additionally, adults with autism who are not interested in interventions focused on modifying their baseline autistic traits may welcome those focused on motor skills that may improve their functional skills or quality of life. Motor interventions in autism are receiving increased empirical attention, with promising improvements observed in motor skills themselves and in downstream social skills for some children, although much of the research to date consists of small pilot or uncontrolled studies.

MExplicit recognition of the scope and relevance of motor differences in autism, such as in DSM, would generate increased interest and funding for comprehensive intervention studies in this area. It could also have important implications for early detection and assessment. Motor skills may be the area in which developmental divergence first appears. Infants later diagnosed with autism show differences in fine and gross motor skills at just 6 months, and large group-level differences are seen at 13 months. Recognizing that motor differences may precede the onset of basic autistic behaviors may also shed light on the developmental pathways of the disease.

An increased awareness of how often autism and motor disorders, such as developmental coordination disorder, co-occur may also prompt clinicians to incorporate simple motor screening and assessment into routine practice. For example, brief parent report screening tools, available free of charge, can identify motor impairments and concomitant motor disorders in children with autism, providing an important opportunity to connect people with relevant services.

Many theoretical questions remain about the specificity of motor disturbance in autism, and these should be the subject of further multi-diagnostic and multidimensional research. For example, which motor differences in early childhood are specific markers of autism, and which reflect more general developmental delays? Our research team is particularly interested in whether there are distinct motor profiles specific to autism that can be analyzed using computational approaches.

We also support the pursuit of larger-scale research into motor skill interventions that can have a significant influence on functioning. While we speculate that this may be a form of intervention that is beneficial for some people with autism, we are not yet aware of any research specifically asking people with autism how differences in motor skills affect their lives and what supports, if any. , would interest them – the job it needs to be done.

We strongly advocate looking beyond interventions that place the burden of change on people with autism, and broader modifications that make existing resources more accessible to people with motor differences. Physical activity, in particular, is beneficial for both physical and mental health, and reducing barriers for all is essential for optimal results in life. the The “Hiking is for Everyone” guidelines, for example, teach caregivers how to support hikers with disabilities and illustrate how increased awareness of different motor needs can go a long way in increasing inclusion.

Ashley from Marchena is assistant professor of psychology and neuroscience at the University of Science in Philadelphia, Pennsylvania. Casey Zampella is a scientist at the Center for Autism Research at the Children’s Hospital of Philadelphia.

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