What’s missing in autism spectrum disorder motor assessments?

Abstract

BackgroundMotor delays and impairments in autism spectrum disorders (ASD) are extremely common and often herald the emergence of pervasive atypical development. Clinical accounts of ASD and standardized measures of motor function have identified deficits in multiple motor domains. However, literature describing frequently used standardized motor assessments in children with ASD, their test properties, and their limitations are sparse.MethodsWe systematically reviewed the literature to identify the most frequently used standardized motor assessments used to evaluate children with ASD from infancy to early childhood. All assessments included were required to possess reference norms, evaluate more than one motor domain, and have undergone some degree of validation.ResultsWe identified six frequently used standardized measures of motor function per our inclusion and exclusion criteria. We investigated and described in detail the psychometric properties of these assessments, their utility for use with children with ASD, and their individual and overall strengths and limitations. The global strengths of these assessments are the ability to identify early development delays and differences in fine and gross motor function in children with ASD. Global limitations of these studies are lack of validation in individuals with ASD and scoring systems that often miss specific and subtle abnormalities.ConclusionsStandardized assessments of motor function have provided valuable information on motor impairments in ASD. However, significant limitations remain in the use of these measures in children with ASD. Moving forward, it is imperative that standardized measures of motor function receive greater validation testing in children with ASD to assess their potential application given the clinical heterogeneity of this condition. In addition, utilizing quantitative measures of motor function should allow for evaluation and comparison of individuals with ASD across the lifespan with varying cognitive and behavioral abilities.

Prevalence of Motor Difficulties in Autism Spectrum Disorder: Analysis of a Population‐Based Cohort

“…While the Vineland is a commonly used tool to evaluate adaptive function in children with ASD, there are several direct observation assessments [e.g., Movement Assessment Battery for Children, Henderson, Sugden, & Barnett, ; Bruininks Oseretsky Test of Motor Proficiency, Bruininks & Bruininks, ], which may provide a more detailed assessment of a child's motor ability. However, there are challenges associated with the use of these assessments; for example, these assessments are not suited to younger children (<3–4 years) and assessment items are often challenging for individuals with intellectual disability [Green et al, ; Wilson, McCracken, Rinehart, & Jeste, ]. Additionally, these assessments are also generally based on the evaluation of performance at one single time point, which may be impacted by mood, fatigue, and behavior on the day.…”

The effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder: A systematic review

“…Third, we recommend using standardized motor tests with strong psychometric properties, and avoiding analyzing subtests or individual test items, which may not demonstrate the documented psychometric properties of the full standardized test. For a current review on the psychometric properties of standardized motor assessments to evaluate children with ASD, refer to Wilson, McCraken, Rinehart, and Jeste (2018).…”

A Review of Functional and Structural Neurobiology of the Action Observation Network in Autism Spectrum Disorder and Developmental Coordination Disorder

“…Motor assessments utilized as a diagnostic tool would be ideal since motor dysfunctions are persistent across development [89,90,91,92] and consist of quantifiable metrics that can more easily be detected and measured than social impairments. While there are several motor impairment measures available, reliability and validity has not been well established in ASD populations (For a review see Wilson et al, [93]).…”