A Multidisciplinary Perspective on Motor Impairment as an Early Behavioural Marker in Children with Autism Spectrum Disorder

Abstract

Objectives:There is no medical test for autism spectrum disorder (ASD), a heterogeneous condition currently defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by dysfunction in social, communication, and behavioural dimensions. There is agreement in the literature that the motor profile of ASD may hold the key to improving clinical and diagnostic definition, with DSM-5 now referring to motor deficits, including "odd gait" (p. 55), as part of the ASD clinical description. This review describes the history of motor impairment in ASD, types of motor problems, and age-related motor findings and highlights evidence gaps and future research. Method: A narrative review is provided of the research literature describing motor impairment in ASD and its ability to differentiate between ASD versus non-ASD cohorts. Results: Findings show differences in motor development in children with ASD from infancy onwards, including difficulties across motor coordination, arm movements, gait, and postural stability. Motor disturbance may appear in young children with ASD prior to social and language difficulties becoming clinically apparent. However, challenges remain in defining and measuring the early motor profile that is specific to ASD. Despite well-established motor impairments in ASD, there is a lack of evidence regarding which motor-based interventions will be effective in this group. Conclusions: Motor impairment holds promise as an early diagnostic sign, a behavioural marker, and a means by which to improve identification and possibly phenotypic delineation in ASD. Further research is required to determine whether motor abnormalities can sensitively differentiate ASD from other developmental conditions and to establish evidenced-based interventions to reduce the associated impairment.

Meta‐Analysis Reveals Gait Anomalies in Autism

“…This in turn, can have a cascading impact on the development of higher‐level motor abilities such as balance and coordination, and also on behavioral and cognitive development. The consequences of these developmental interactions may underlie the way gait changes or varies over time between individuals [Leonard, 2016; May et al, 2016; Wilson, Enticott, & Rinehart, 2018]. These brain‐environment interactions may underlie the differences in gait development and how gait changes or varies over time between individuals.…”

Motor Skills as Moderators of Core Symptoms in Autism Spectrum Disorders: Preliminary Data From an Exploratory Analysis With Artificial Neural Networks

“…Moreover, motor problems are currently reported as associated features supporting the diagnosis of ASD (American Psychiatric Association [APA], 2013). To date, impairments have been highlighted in various motor domains including both gross and fine motor areas, motor coordination, postural control and standing balance (Fournier et al, 2010; Esposito et al, 2011; Longuet et al, 2012; Travers et al, 2013; May et al, 2016). The high variance in findings may suggest a broad spectrum of motor impairments.…”

Quantitative gait assessment in children with 16p11.2 syndrome

“…Among the affected developmental functions, motor impairments represent the earlier and most visible signs [1, 2]. Yet, the motor phenotypes are often difficult to quantify precisely in children with neurodevelopmental disorders especially when accompanied by high behavioral comorbidities such as those with autism spectrum disorder (ASD) [3] who may display low compliance, distractibility, and poor imitation skills. These behavioral challenges often confound traditional command-based motor assessments.…”