Moving Toward Understanding Autism: Visual-Motor Integration, Imitation, and Social Skill Development

Atypical development of sequential manual motor planning and visuomotor integration in children with autism at early school-age: A longitudinal kinematic study

Sensorimotor difficulties are common in children with autism spectrum disorder, and it has been suggested that motor planning problems underlie their atypical movements. At early school-age, motor planning development typically involves changes in visuomotor integration, a function known to be affected in autism spectrum disorder. However, there is a lack of detailed characterization of typical motor planning development during this stage, and how motor planning develops in children with autism spectrum disorder is largely unknown. This longitudinal kinematic study examined goal-directed sequential manual movements in children with autism spectrum disorder and in typically developing children across ages 7, 8, and 9 years. We manipulated goal-difficulty and availability of initial visual information to investigate visuomotor integration and chaining of subparts during movement performance. The results revealed emerging group differences at older age, suggesting atypical motor planning development in children with autism spectrum disorder. Notably, unlike the typically developing group, availability of initial visual information did not facilitate motor planning for the autism spectrum disorder group. The results show that motor planning differences in autism spectrum disorder appear related to atypical visuomotor integration and global processing of sensorimotor information. The findings also emphasize the importance of considering developmental aspects in research and practice related to motor problems in children with autism spectrum disorder.Lay abstractMany children with autism struggle with movement difficulties, yet the causes of these difficulties remain unclear. One possible explanation is atypical motor planning and integration of visual and motoric information. Before performing a goal-directed movement, the brain creates a prediction of the movement based on visual and sensory information and previous experience, forming a "blueprint" of the motor steps needed to achieve the goal. This process is called motor planning. During movement, adjustments to the plan can be made through feedback mechanisms. This longitudinal study aimed to examine the development of motor planning in children with autism and typically developing children over early school-age (7-9 years). The children performed a sequential manual peg-rotation task, which involved grasping, rotating, and placing a peg, while detailed measures of movement were collected. Task end-goal difficulty varied, and the goal was either initially occluded or fully visible. The results revealed that children with autism showed atypical motor planning development compared with typically developing peers, and these differences became more pronounced as the children grew older. As the typically developing children matured, they appeared to rely more on initial visual information, which assisted them in motor planning. However, this facilitation did not occur for children with autism. These findings suggest that the differences in motor planning seen in children with autism may be linked to atypical visuomotor integration, highlighting the need for individualized interventions. Furthermore, it is crucial to consider developmental aspects to fully understand motor planning in children with autism.

Mechanisms of Altered Imitation in Autism Spectrum Disorders

Imitation plays a critical role in enhancing social reciprocity and social/non-social skill learning. Accordingly, impaired imitation may have downstream implications on skill acquisition in autism. Social, motor, representational, and executive processes contribute to imitation performance, but it is unknown the degree to which differences in these domains contribute to imitation differences in autism. In the present study, we evaluated the role of various psychological mechanisms of autism-related imitation differences using mediation models. We assessed autistic and non-autistic 7-12-year-old children (n = 708) with FSIQ ≥ 80, using a wide battery of performance-based and parent-report tests that measured meaningful and non-meaningful gesture imitation performance, motor execution, action representation, social motivation, and executive function processes. Multiple marginal mediation analyses revealed that motor execution tests most strongly mediated imitation deficits in autism, though effects from social motivation, action representation, and executive function also partially mediated the relationship between autism diagnosis and imitation performance. Using cross-validated regression models, the domains tested here accounted for 39% of the variation in imitation performance. Results are contextualized across a broad range of experimental and observational studies with respect to the prompted imitation task utilized here. Future research will require longitudinal data, particularly from earlier stages of development.

Sensory-movement underpinnings of lifelong neurodivergence: getting a grip on autism

While the autism diagnosis emphasizes "deficits" in social communication, the article advances that sensory-movement differences underpin autism through a review of the following sources of evidence. This account critically challenges "autistic regression", with evidence that sensory-movement features appear by birth as the earliest signs of autism and underlie the behavioral differences used for diagnosis, which may reflect adaptations to inherent differences and misunderstandings from others. Sensory and motor differences are salient to autistic people, but they often go underrecognized by others. They cause cascading effects in infancy on behavior and communication through differences in sensorimotor learning, automatic imitation, eye contact, sensory perception, and interests. The article then explains how sensory processing differences may influence reduced perceptual narrowing, which involves a bottom-up information processing style grounded in the surrounding environment. Furthermore, this bottom-up processing may grow from reduced sensory integration in feedback loops potentially involving the cerebellum of the brain. The article then moves into implications for the widespread consequences of these inherent differences on quality of life. The article closes with implications for autism as a construct (including underestimated empathy and pain), testing the theory, providing sensory-sensitive support and acceptance of autistic people, and applications to diverse autistic people. The theory may apply particularly well to autistic women and girls, autistic people with speech divergence, autistic people with ADHD, and autistic people with co-occurring sensory and motor-related neurodivergences. Throughout the article, the theory also provides clinical, neurological, and experiential evidence for sensory and motor differences as lifelong, challenging the notion of "losing" (an) autism (diagnosis) as instead reflecting (risky and not necessarily "successful") camouflaging.

Hidden social and emotional competencies in autism spectrum disorders captured through the digital lens

Background/objectives

The current deficit model of autism leaves us ill-equipped to connect with persons on the spectrum, thus creating disparities and inequalities in all aspects of social exchange in which autistic individuals try to participate. Traditional research models also tend to follow the clinical definition of impairments in social communication and emotions without offering personalized therapeutic help to autistic individuals. There is a critical need to redefine autism with the aim of co-adapting and connecting with this exponentially growing sector of society. Here, we hypothesize that there are social and emotional competencies hidden in the movements' nuances that escape the naked eye. Further, we posit that we can extract such information using highly scalable means such as videos from smartphones.

Methods

Using a phone/tablet app, we recorded brief face videos from 126 individuals (56 on the spectrum of autism) to assess their facial micro-motions during several emotional probes in relation to their resting state. We extracted the micro-movement spikes (MMSs) from the motion speed along 68 points of the OpenFace grid and empirically determined the continuous family of probability distribution functions best characterizing the MMSs in a maximum likelihood sense. Further, we analyzed the action units across the face to determine their presence and intensity across the cohort.

Results

We find that the continuous Gamma family of probability distribution functions describes best the empirical face speed variability and offers several parameter spaces to automatically classify participants. Unambiguous separation at rest denotes marked differences in stochastic patterns between neurotypicals and autistic individuals amenable to further separate autistic individuals according to the required level of support. Both groups have comparable action units present during emotional probes. They, however, operate within parameter ranges that fall outside our perceptual umwelt and, as such, do not meet our expectations from prior experiences. We cannot detect them.

Conclusions

This work offers new methods to detect hidden facial features and begin the path of augmenting our perception to include those signatures of the autism spectrum that can enhance our capacity for social interactions, communication, and emotional support to meet theirs.

Motor difficulties in children with neurodevelopmental conditions: a report from a cross-national study in Belgian and Italian children

Motor behavior alterations are common in neurodevelopmental disorders (NDDs), including autism, developmental coordination disorder (DCD), and attention deficit hyperactivity disorder (ADHD), but the extent of motor impairment remains unclear. In autism and ADHD, motor difficulties may be linked to co-occurring DCD, which often goes unrecognized. We aimed to map the prevalence of DCD in autism and ADHD, and to explore motor skill difficulties using the Movement Assessment Battery for Children-2 (MABC-2), by comparing children with typical motor development (TMD) with those who have NDDs, and by identifying specific profiles among NDDs. A combined sample of participants (n = 215), including autistic children with(out) intellectual disability (ID) and children with ADHD, DCD, and TMD, performed the MABC-2. Depending on co-occurring DCD/ID, subgroups were composed: autism-only (n = 17), autism + ID (n = 17), autism + DCD (n = 40), ADHD-only (n = 14), ADHD + DCD (n = 12), DCD (n = 25), and TMD (n = 59). MABC-2 differences between TMD/NDDs (Mann-Whitney U test) and among NDDs (Kruskal-Wallis test) were assessed. DCD occurred in 70.2% of the autistic children without ID and in 46.2% of those with ADHD. Children with NDDs performed significantly worse than the TMD (p < 0.001). Manual dexterity skills, aiming and catching, and balance were significantly different across the NDD subgroups (p ≤ 0.001). Particularly children with ( +)DCD and autism + ID performed worse on manual dexterity skills. Children with ( +)DCD were outperformed on aiming and catching. All subgroups, except the ADHD-only group, performed poorly on balance.

CONCLUSION

Distinct motor difficulties were identified across various NDDs. Children with co-occurring ID or DCD exhibit unique challenges, stressing the importance of motor profile subgrouping.

WHAT IS KNOWN

• Despite the common occurrence of motor behavior in neurodevelopmental disorders, the extent of motor impairment remains unclear. • Motor difficulties in autism and ADHD may be linked to co-occurring DCD, which often goes unrecognized.

WHAT IS NEW

• DCD occurred in 70% of the autistic children without ID and in 46% of those with ADHD. • Children with co-occurring ID or DCD exhibit unique challenges, stressing the importance of motor profile subgrouping.

Atypical Impact of Action Effect Delay on Motor Performance in Autism

Atypical sensory perception and motor impairments are primary features of autism spectrum disorder (ASD) that indicate atypical development and predict social and non-social challenges. However, their link is poorly understood. Sensory perception is often integrated with motor processes when a sensory effect is temporally contiguous with the motor response. Such sensory-motor coupling further improves motor behavior. Previous studies indicate alterations in sensory perception of action-effect temporal contiguity in ASD, which bares the question of how it may impact motor performance. People diagnosed with ASD and typically developed (TD) participants performed a speeded reaction-time task previously established to capture the facilitating impact of action's perceptual effect on motor response selection. The sensitivity of this mechanism to delays in the effect was measured, manipulating the action-effect temporal contiguity in a within-subject design. An immediate action effect (compared to a No-effect condition) facilitated response selection in the TD group. This facilitation effect was evident in the ASD group but did not show the typical sensitivity to the effect delay. While in the TD group, RT was shorter in the short (225ms) compared to the long (675ms) action effect delay condition, this distinguished pattern was absent in the ASD group. The findings provide supporting evidence that atypical motor performance in ASD results, at least in part, from an altered sensory perception of action effect temporal contiguity. We discuss the results in light of the reduced perceptual specialization account in ASD and its potential for undermining adaptive sensorimotor processes.

Evaluating Computerised Assessment of Motor Imitation (CAMI) for identifying autism-specific difficulties not observed for attention-deficit hyperactivity disorder or neurotypical development

BACKGROUND

Reliable and specific biomarkers that can distinguish autism spectrum disorders (ASDs) from commonly co-occurring attention-deficit/hyperactivity disorder (ADHD) are lacking, causing misses and delays in diagnosis, and reducing access to interventions and quality of life.

AIMS

To examine whether an innovative, brief (1-min), videogame method called Computerised Assessment of Motor Imitation (CAMI), can identify ASD-specific imitation differences compared with neurotypical children and children with ADHD.

METHOD

This cross-sectional study used CAMI alongside standardised parent-report (Social Responsiveness Scale, Second Edition) and observational measures of autism (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2), ADHD (Conners) and motor ability (Physical and Neurological Examination for Soft Signs). The sample comprised 183 children aged 7-13 years, with ADHD (without ASD), with ASD (with and without ADHD) and who were neurotypical.

RESULTS

Regardless of co-occurring ADHD, children with ASD showed poorer CAMI performance than neurotypical children (P < 0.0001; adjusted R2 = 0.28), whereas children with ADHD and neurotypical children showed similar CAMI performance. Receiver operating curve and support vector machine analyses showed that CAMI distinguishes ASD from both neurotypical children (80% true positive rate) and children with ADHD (70% true positive rate), with a high success rate significantly above chance. Among children with ASD, poor CAMI performance was associated with increased autism traits, particularly ADOS-2 measures of social affect and restricted and repetitive behaviours (adjusted R2 = 0.23), but not with ADHD traits or motor ability.

CONCLUSIONS

Four levels of analyses confirm that poor imitation measured by the low-cost and scalable CAMI method specifically distinguishes ASD not only from neurotypical development, but also from commonly co-occurring ADHD.

Focusing Attention to Improve Throwing Skills in Children With Autism Spectrum Disorder: Exploring the Influence of Working Memory

This study is aimed at investigating the impact of internal and external attention focus on learning a throwing skill in children with autism, as well as the relationship between working memory and learning rate. Twenty-four children aged 6-8 years with autism were assigned to internal and external attention groups. Participants performed a throwing task while their working memory was assessed using Cornoldi's working memory test. The data was analyzed using ANOVA with repeated measures involving two attention instructions and five blocks during the acquisition stage. An independent t-test was conducted during the retention phase. Furthermore, a Pearson correlation test was utilized to explore any potential relationship between working memory and performance in both the acquisition and retention stages. Data analysis revealed no significant difference between the internal and external attention groups during the acquisition phase (p > 0.05), but a significant difference was found in the retention phase (p < 0.05). There was no correlation between working memory and learning outcomes (p > 0.05). The results suggest that internal attention may enhance motor learning in children with autism, and reducing working memory load does not necessarily favor external attention.

Prospective Interrelation Between Sensory Sensitivity and Fine Motor Skills During the First 18 Months Predicts Later Autistic Features

Sensory features are included in the diagnostic criteria of autism and atypical sensory responsiveness may produce "cascading effects" on later development. Similarly, autistic individuals often struggle with motor coordination and early delays in the motor domain appear to be linked to later development. However, the longitudinal interrelation between early sensory profiles and motor features on later socio-communicative skills remains to be defined. This study aimed to investigate whether sensory sensitivity impacts fine motor abilities and vice versa from 12 to 18 months of age and to examine how sensory-motor interplay would be associated with later autistic traits at 24-36 months of age. The sample included 118 infant siblings of autistic children recruited at 12 months of age. Sensory sensitivity and eye-hand coordination were assessed at 12 and 18 months of age and autistic traits were evaluated at 24-36 months of age. Cross-lagged panel analysis revealed significant within-domain effects for sensory sensitivity and eye-hand coordination from 12 to 18 months. Furthermore, a significant association between these two domains on later autistic traits was found. In analyzing the longitudinal bidirectional relationship, we found that lower eye-hand coordination skills at 12 months predicted later sensory sensitivity at 18 months, and in turn, social communication skills at 24-36 months. The present study offers new empirical evidence supporting the potential clinical value of including sensory and motor measures besides social communication skills within early autism surveillance programs.

Functional Neurological Disorder and Autism Spectrum Disorder: A Complex and Potentially Significant Relationship

INTRODUCTION

Functional neurological disorder (FND) and autism spectrum disorder (ASD) are two complex neuropsychiatric conditions that have been historically classified within psychiatric domains, resulting in a lack of extensive research, insufficient clinical recognition, and persistent societal stigma. In recent years, there has been an increasing recognition among professionals and affected individuals of their possible overlap. This review explores the potential clinical and mechanistic overlap between FND and ASD, with particular attention to shared symptoms across sensory, motor, and psychiatric domains.

METHODS

We conducted a narrative analysis utilizing the PubMed, CINAHL, MEDLINE, and ScienceDirect databases from inception to June 2024. The search employed specific MeSH terms related to ASD and FND. Given the limited data availability, we included all relevant articles that explored the potential connections between FND and ASD, focusing on established findings and theoretical hypotheses areas.

RESULTS

Scientific evidence indicates that FND and ASD may co-occur more frequently than previously acknowledged and with notable overlaps in their clinical presentations and pathophysiology. Theoretical models that have been applied to FND and ASD, such as the Bayesian brain theory and the tripartite model of autism, may provide valuable insights into the intersection of these conditions. Although much of the current evidence remains speculative, it underscores the need for hypothesis-driven research to investigate these potential connections further.

CONCLUSION

ASD and FND are heterogeneous conditions that appear to co-occur in a subset of individuals, with overlapping symptomatology and possibly shared underlying mechanisms. This hypothesis-generating review emphasizes the need for further research to better understand these links, ultimately aiming to improve clinical recognition and develop targeted interventions that enhance the quality of life for affected individuals.

Interceptive abilities in autism spectrum disorder: Comparing naturalistic and virtual visuomotor tasks

A growing body of research reveals that autistic individuals exhibit motor coordination challenges. Multiple theoretical frameworks propose that the seemingly disparate features of autism may arise from a common underlying process: a diminished ability to make predictions. Sensorimotor skills, such as catching a ball, critically rely on predicting the ball's trajectory as well as anticipatory coordination of the entire body. Here, we assessed four different naturalistic and virtual interception tasks with 31 neurotypical and 23 autistic children (ages 7-12). In a naturalistic setting, participants caught the ball either with their hands or a hand-held funnel with an enlarged catch area that also prevented the ball from bouncing off. A virtual setup reduced whole-body demands, as children only moved a paddle to catch or bounce a ball on a screen. Control tasks, involving rapid reaching to grasp a static object and quiet standing, which largely eliminated the requirements for prediction, were also tested. Results from all task variations demonstrated that autistic children completed fewer successful interceptions, suggesting that predictive requirements, inherent to all interception tasks, played a critical role. Effect sizes in the virtual tasks were smaller. Correlations of the task metrics with behavioral assessments rendered the strongest correlations with Praxis scores. The control tasks showed no differences between autistic and neurotypical children. These findings lend support to the emerging hypothesis that predictive challenges are present in autism. Further research with larger sample sizes will help identify to what extent these visuomotor differences may inform core domains of autism.

The Experiences of Motor Skill Development in Children with Autism Spectrum Disorder (ASD) Reflected through Parental Responses

Background/Objectives: Understanding movement development in children with autism spectrum disorder (ASD) is critical for creating effective intervention strategies. This study aims to explore parental perspectives on the movement development of children with ASD, focusing on identifying common challenges and successful strategies. The objective is to analyze the experiences of parents to highlight the most effective approaches to support motor, communication, and social skills development in these children. Methods: Using a qualitative approach, we conducted in-depth interviews with parents of children with ASD. The data were analyzed using open and selective coding to identify key themes related to movement development challenges and strategies. The analysis included cross-referencing with the existing literature to support parental insights. Results: This study identified several key themes, including communication barriers, social interaction difficulties, and the importance of personalized movement programs. Parents reported significant challenges in understanding and addressing their children's movement needs, particularly in group settings. However, activities such as water programs, music and dance, and animal-assisted therapies were found to be highly engaging. Motivation was a critical factor, with rewards and active parental involvement enhancing participation. Conclusions: This study highlights the crucial role of a supportive environment, including professional guidance and family support, in the success of movement development programs.

The relationships between language, functional hearing, social, and motor development skills in children with early cochlear implants

PURPOSE

The purpose of this study was to investigate the relations between functional hearing, language, social, bilateral coordination and manual dexterity skills in children with early cochlear implants (CIs).

METHODS

Thirty children with CIs were included in this study. The manual dexterity and bilateral coordination development of the participants were evaluated with Manual Dexterity and Bilateral Coordination subtests of Bruininks-Oseretsky Motor Proficiency-2 (BOT-2). Their language skills were assessed by the Test of Early language Development-3. To assess the functional hearing of participants the Functioning After Pediatric Cochlear Implantation scale (FAPCI) was administered their caregivers. Also, the Social Skills Evaluation Scale was administered to participants' teachers to asses their social skills.

RESULTS

There were significant correlations between participants' receptive and expressive language skills, Manual Dexterity, and FAPCI scores (p < 0.05). There were also significant relationships between the SSES and FAPCI scores of the participants (p < 0.05). However, the Bilateral Coordination subtest did not show any significant correlation with any of the measurements (p > 0.05).

CONCLUSION

The results suggest that the language, manual dexterity and functional hearing abilities of children with CIs are closely related. Although, there were no significant correlations between all of the measurement, it is important to look beyond hearing and speech evaluations to assess the whole child.

Higher or lower? Interpersonal behavioral and neural synchronization of movement imitation in autistic children

How well autistic children can imitate movements and how their brain activity synchronizes with the person they are imitating have been understudied. The current study adopted functional near-infrared spectroscopy (fNIRS) hyperscanning and employed a task involving real interactions involving meaningful and meaningless movement imitation to explore the fundamental nature of imitation as a dynamic and interactive process. Experiment 1 explored meaningful and meaningless gesture imitation. The results revealed that autistic children exhibited lower imitation accuracy and behavioral synchrony than non-autistic children when imitating both meaningful and meaningless gestures. Specifically, compared to non-autistic children, autistic children displayed significantly higher interpersonal neural synchronization (INS) in the right inferior parietal lobule (r-IPL) (channel 12) when imitating meaningful gestures but lower INS when imitating meaningless gestures. Experiment 2 further investigated the imitation of four types of meaningless movements (orofacial movements, transitive movements, limb movements, and gestures). The results revealed that across all four movement types, autistic children exhibited significantly lower imitation accuracy, behavioral synchrony, and INS in the r-IPL (channel 12) than non-autistic children. This study is the first to identify INS as a biomarker of movement imitation difficulties in autistic individuals. Furthermore, an intra- and interindividual imitation mechanism model was proposed to explain the underlying causes of movement imitation difficulties in autistic individuals.

Sensory Processing Challenges in Children with Neurodevelopmental Disorders and Genetic Conditions: An Observational Study

Sensory processing challenges are crucial yet often neglected aspects in the care of children with neurodevelopmental disorders and genetic conditions. They represent a key area of interest in neuroscience, as they significantly impact children's daily functioning and quality of life. This observational study examines these challenges in a group of 614 children, aged 3 to 14 years and 11 months, divided into three groups: 183 with neurodevelopmental disorders (autism spectrum disorder, attention deficit hyperactivity disorder, developmental delays, and learning disorders), 89 with genetic conditions (22q11.2 deletion syndrome, Williams syndrome, and pseudohypoparathyroidism), and 342 controls. Sensory processing was assessed using Sensory Profile 2 (SP2). Results indicated that children with neurodevelopmental disorders and genetic conditions exhibited significant sensory processing difficulties compared to controls. SP2 identified distinct sensory challenges across different sensory systems, varying by diagnosis. Notably, genetic conditions appeared to have a more generalised impact across multiple sensory systems, while neurodevelopmental disorders tended to affect specific systems more narrowly. These findings highlight the importance of early identification and tailored evidence-based interventions to address these specific sensory processing issues. Further research should explore the long-term impact of these interventions in these different populations and their integration into broader therapeutic programmes.

Proprioception, Emotion and Social Responsiveness in Children with Developmental Disorders: An Exploratory Study in Autism Spectrum Disorder, Cerebral Palsy and Different Neurodevelopmental Situations

Proprioception has long been linked with emotional dysregulation in neurotypical adults. Neuropediatric disorders such as autism spectrum disorder (ASD) and cerebral palsy (CP) are distinct entities and yet both present with deficits and challenges in sensory processing and the regulation of emotions. This study aimed to explore the relationship between proprioception and emotional-social performance in children and to compare proprioception and emotional-social performance in different underlying neurodevelopmental conditions. For this purpose, this cross-sectional study included 42 children with ASD, 34 children with CP and 50 typically developing peers. Proprioceptive acuity, proprioceptive reactive behavior as well as emotion regulation and social responsiveness were assessed. The results show a significant correlation between proprioceptive deficits and emotional difficulties in this pediatric sample, with distinct proprioceptive impairment patterns according to the underlying neurological disorder. Children with CP showed significant emotional knowledge deficits, while children with ASD predominantly showed challenges in social responsiveness. These data thus suggest a differentiated impact of proprioception on emotional-social performance in neurodevelopmental disorders and highlight proprioception as a potential therapeutic target for balancing emotion regulation in children with neurodevelopmental conditions.

Beyond words: an investigation of fine motor skills and the verbal communication spectrum in autism

Introduction

This study investigated the associations between fine motor skills and expressive verbal abilities in a group of 97 autistic participants (age 8-17, mean=12.41) and 46 typically developing youth (age 8-17, mean=12.48).

Methods

Participants completed assessments of motor and verbal communication skills, including finger tapping speed, grooved pegboard, grip strength, visual-motor integration tasks, and measures of speech and communication skills. ASD group performance on motor tests was compared to controls. Non-parametric tests were used to analyze group differences and correlations between motor and verbal communication skills. Based on prior research, we hypothesized that individuals on the autism spectrum would exhibit deficits in fine motor speed, dexterity, pencil motor control, but not manual motor strength. Additionally, we expected that impaired fine motor skills would be linked to poorer performance on standardized measures of verbal abilities.

Results

The results indicated that 80% of autistic participants demonstrated an impairment on at least one measure of motor skills, and as a group, they exhibited significantly poorer fine motor performance compared to the non-ASD group in dominant hand finger tapping speed, bilateral fine motor dexterity measured via the grooved pegboard task, and pencil motor coordination and visual-motor integration measured on the Beery-Buktenica Developmental Test of Visual-Motor Integration-Sixth Edition. Moreover, impaired fine motor skills were associated with poorer performance on standardized clinical measures of verbal abilities, including articulation errors, receptive and expressive language and vocabulary, rapid naming, oromotor sequencing, and parent reported functional communication skills and social communication symptoms.

Discussion

Overall,our findings suggest there is a high prevalence of fine motor impairments in ASD, and these impairments were associated with a range of verbal abilities. Further research is warranted to better understand the underlying mechanisms of these associations and develop targeted interventions to address both fine motor and verbal impairments in ASD.

Auditory feedback decreases timing variability for discontinuous and continuous motor tasks in autistic adults

Introduction

Autistic individuals demonstrate greater variability and timing error in their motor performance than neurotypical individuals, likely due at least in part to atypical cerebellar characteristics and connectivity. These motor difficulties may differentially affect discrete as opposed to continuous movements in autistic individuals. Augmented auditory feedback has the potential to aid motor timing and variability due to intact auditory-motor pathways in autism and high sensitivity in autistic individuals to auditory stimuli.

Methods

This experiment investigated whether there were differences in timing accuracy and variability in autistic adults as a function of task (discontinuous vs. continuous movements) and condition (augmented auditory feedback vs. no auditory feedback) in a synchronization-continuation paradigm. Ten autistic young adults aged 17-27 years of age completed the within-subjects study that involved drawing circles at 800 milliseconds intervals on a touch screen. In the discontinuous task, participants traced a series of discrete circles and paused at the top of each circle for at least 60 milliseconds. In the continuous task, participants traced the circles without pausing. Participants traced circles in either a non-auditory condition, or an auditory condition in which they heard a tone each time that they completed a circle drawing.

Results

Participants had significantly better timing accuracy on the continuous timing task as opposed to the discontinuous task. Timing consistency was significantly higher for tasks performed with auditory feedback.

Discussion

This research reveals that motor difficulties in autistic individuals affect discrete timing tasks more than continuous tasks, and provides evidence that augmented auditory feedback may be able to mitigate some of the timing variability present in autistic persons' movements. These results provide support for future investigation on the use of music-based therapies involving auditory feedback to address motor dysfunction in autistic individuals.

Motor deficits in autism differ from that of developmental coordination disorder

LAY ABSTRACT

A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.

Sensory Phenotypes in Autism: Making a Case for the Inclusion of Sensory Integration Functions

Sensory features are part of the diagnostic criteria for autism and include sensory hypo/hyper reactivity and unusual sensory interest; however, additional sensory differences, namely differences in sensory integration, have not been routinely explored. This study characterized sensory integration differences in a cohort of children (n = 93) with a confirmed diagnosis of autism (5-9 years) using a standardized, norm-referenced battery. Mean z scores, autism diagnostic scores, and IQ are reported. Participants showed substantial deficits in tactile perception, praxis, balance, visual perception, and visual-motor skills. Relationship with autism diagnostic test scores were weak or absent. Findings suggest additional sensory difficulties that are not typically assessed or considered when characterizing sensory features in autism. These data have implications for a greater understanding of the sensory features in the autism phenotype and the development of personalized treatments.

Observational learning of atypical biological kinematics in autism

Observing and voluntarily imitating the biological kinematics displayed by a model underpins the acquisition of new motor skills via sensorimotor processes linking perception with action. Differences in voluntary imitation in autism could be related to sensorimotor processing activity during action-observation of biological motion, as well as how sensorimotor integration processing occurs across imitation attempts. Using an observational practice protocol, which minimized the active contribution of the peripheral sensorimotor system, we examined the contribution of sensorimotor processing during action-observation. The data showed that autistic participants imitated both the temporal duration and atypical kinematic profile of the observed movement with a similar level of accuracy as neurotypical participants. These findings suggest the lower-level perception-action processes responsible for encoding biological kinematics during the action-observation phase of imitation are operational in autism. As there was no task-specific engagement of the peripheral sensorimotor system during observational practice, imitation difficulties in autism are most likely underpinned by sensorimotor integration issues related to the processing of efferent and (re)afferent sensorimotor information during trial-to-trial motor execution.

A multimodal approach can identify specific motor profiles in autism and attention-deficit/hyperactivity disorder

It is still unclear whether and to what extent the motor difficulties are specific to autism. This study aimed to determine whether a multimodal assessment of motor skills could accurately discriminate autistic children from attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) peers. Seventy-five children, aged 7-13, equally divided into three groups, were assessed with the developmental coordination disorder questionnaire (DCDQ), the movement assessment battery for children 2 (MABC2), the sensorimotor subtests of NEPSY-II, and the kinematic analysis of a reach-to-drop task. Principal component analysis (PCA) on DCDQ subscales revealed one factor-Caregiver Report-, whereas MABC2/NEPSY-II scores identified three factors-namely, Object Interception and Balance, Motor Imitation, and Fine-Motor Skills-. Lastly, PCA on kinematic variables identified four factors: PC1, loaded by the parameters of velocity and acceleration throughout the task, PC2 and PC3 involved the temporal parameters of the two submovements, and PC4 accounted for the wrist inclination at ball drop. When comparing autistic and TD children, Caregiver Report and Motor Imitation factors predicted membership with 87.2% of accuracy. In the model comparing ADHD and TD groups, Caregiver Report and Fine-Motor Skills predicted membership with an accuracy of 73.5%. In the last model, the Object Interception and Balance factor differentiated autistic children from ADHD with an accuracy of 73.5%. In line with our previous findings, kinematics did not differentiate school-aged autistic children from ADHD and TD peers. The present findings show that specific motor profiles in autism and ADHD can be isolated with a multimodal investigation of motor skills.

Measuring Dyspraxia in Autism using a Five-Minute Praxis Exam

Background

Difficulties with praxis, the ability to perform learned skilled movements, have been robustly demonstrated in autism spectrum disorder (autism). However, praxis assessment is not routinely included in autism characterization batteries, in part because it is traditionally time consuming to administer and score. We test whether dyspraxia in autism can be captured with a brief measure.

Method

Youth with autism (n = 41) and matched typically developing controls (n = 32), aged 8 to 16 years, completed a 5-minute praxis battery. The 19-item battery included four subtests: gesture to command, tool use, familiar imitation, and meaningless imitation. Video recordings were coded for error types and compared to participant characterization variables.

Results

Consistent with research using a lengthy battery, autistic youth made more errors overall, with a large effect size. Groups demonstrated similar distributions of error types, suggesting that dyspraxia in autism is not limited to a particular error form. In the autism group, praxis was associated with adaptive functioning, but not autism traits.

Conclusions

A shortened battery is sufficiently sensitive to praxis differences between autistic and typically developing youth, increasing the feasibility of including praxis within clinical assessments or larger research batteries aimed at testing relationships with downstream skills.

Cued motor processing in autism and typical development: A high-density electrical mapping study of response-locked neural activity in children and adolescents

Motor atypicalities are common in autism spectrum disorder (ASD) and are often evident prior to classical ASD symptoms. Despite evidence of differences in neural processing during imitation in autistic individuals, research on the integrity and spatiotemporal dynamics of basic motor processing is surprisingly sparse. To address this need, we analysed electroencephalography (EEG) data recorded from a large sample of autistic (n = 84) and neurotypical (n = 84) children and adolescents while they performed an audiovisual speeded reaction time (RT) task. Analyses focused on RTs and response-locked motor-related electrical brain responses over frontoparietal scalp regions: the late Bereitschaftspotential, the motor potential and the reafferent potential. Evaluation of behavioural task performance indicated greater RT variability and lower hit rates in autistic participants compared to typically developing age-matched neurotypical participants. Overall, the data revealed clear motor-related neural responses in ASD, but with subtle differences relative to typically developing participants evident over fronto-central and bilateral parietal scalp sites prior to response onset. Group differences were further parsed as a function of age (6-9, 9-12 and 12-15 years), sensory cue preceding the response (auditory, visual and bi-sensory audiovisual) and RT quartile. Group differences in motor-related processing were most prominent in the youngest group of children (age 6-9), with attenuated cortical responses observed for young autistic participants. Future investigations assessing the integrity of such motor processes in younger children, where larger differences may be present, are warranted.

Mapping the Physical Language of Children Diagnosed with Autism: A Preliminary Study

Children diagnosed with autism spectrum disorder have a unique motor profile, characterized by, for example, unusual posture or compulsive use of the body. However, not much is known about specific characteristics of their physical language, such as their movement direction, their self-touch pattern, etc., and even less is known about these characteristics with regard to their typically developing siblings. In this first of its kind study, we attempted to map the physical language of children diagnosed with autism spectrum disorder and to compare it to their typically developing siblings. To this end, we recruited 12 pairs of siblings, comprising one sibling with a diagnosis of autism and one sibling who is typically developing. The siblings were asked to play for 10 min and were videotaped throughout the interaction. We evaluated the siblings' physical language using Laban's movement analysis. We found significant and substantial differences between the physical language of the children diagnosed with autism and their typically developing siblings. The results are discussed in terms of the implications of the differences in physical language between the two populations and how movement analysis could be important for interventions in order to improve the communication and social abilities of ASD children.

From "one big clumsy mess" to "a fundamental part of my character." Autistic adults' experiences of motor coordination

Altered motor coordination is common in autistic individuals affecting a range of movements such as manual dexterity, eye-hand coordination, balance and gait. However, motor coordination is not routinely assessed leading to undiagnosed and untreated motor coordination difficulties, particularly in adults. Few studies have investigated motor coordination difficulties and their impact from the viewpoint of autistic people. Therefore, the current study used FGs and thematic analysis to document the experience of motor coordination difficulties from the viewpoint of 17 autistic adults. Four main themes were identified. First, motor coordination difficulties were pervasive and variable, being present life-long and within multiple movements and affecting many aspects of life. Furthermore, the nature of the difficulties was variable within and between participants along with differing awareness of coordination ability. Second, participants described motor coordination as an active process, requiring concentration for most actions and at a level seemingly greater than other people. Third, motor coordination difficulties impacted upon social and emotional wellbeing by placing strain on relationships, prompting bullying and exclusion, putting safety at risk and causing a range of negative emotions. Fourth, in the absence of any support, participants described multiple learning and coping strategies. Findings highlight how it is essential to address the current lack of support for motor coordination considering the significant social and emotional consequences described by our participants. Further investigation of motor learning and interactions between sensory and motor performance in autistic adults is also warranted.

A tablet-based game for the assessment of visual motor skills in autistic children

Increasing evidence suggests that early motor impairments are a common feature of autism. Thus, scalable, quantitative methods for measuring motor behavior in young autistic children are needed. This work presents an engaging and scalable assessment of visual-motor abilities based on a bubble-popping game administered on a tablet. Participants are 233 children ranging from 1.5 to 10 years of age (147 neurotypical children and 86 children diagnosed with autism spectrum disorder [autistic], of which 32 are also diagnosed with co-occurring attention-deficit/hyperactivity disorder [autistic+ADHD]). Computer vision analyses are used to extract several game-based touch features, which are compared across autistic, autistic+ADHD, and neurotypical participants. Results show that younger (1.5-3 years) autistic children pop the bubbles at a lower rate, and their ability to touch the bubble's center is less accurate compared to neurotypical children. When they pop a bubble, their finger lingers for a longer period, and they show more variability in their performance. In older children (3-10-years), consistent with previous research, the presence of co-occurring ADHD is associated with greater motor impairment, reflected in lower accuracy and more variable performance. Several motor features are correlated with standardized assessments of fine motor and cognitive abilities, as evaluated by an independent clinical assessment. These results highlight the potential of touch-based games as an efficient and scalable approach for assessing children's visual-motor skills, which can be part of a broader screening tool for identifying early signs associated with autism.

Rapid assessment of hand reaching using virtual reality and application in cerebellar stroke

The acquisition of sensory information about the world is a dynamic and interactive experience, yet the majority of sensory research focuses on perception without action and is conducted with participants who are passive observers with very limited control over their environment. This approach allows for highly controlled, repeatable experiments and has led to major advances in our understanding of basic sensory processing. Typical human perceptual experiences, however, are far more complex than conventional action-perception experiments and often involve bi-directional interactions between perception and action. Innovations in virtual reality (VR) technology offer an approach to close this notable disconnect between perceptual experiences and experiments. VR experiments can be conducted with a high level of empirical control while also allowing for movement and agency as well as controlled naturalistic environments. New VR technology also permits tracking of fine hand movements, allowing for seamless empirical integration of perception and action. Here, we used VR to assess how multisensory information and cognitive demands affect hand movements while reaching for virtual targets. First, we manipulated the visibility of the reaching hand to uncouple vision and proprioception in a task measuring accuracy while reaching toward a virtual target (n = 20, healthy young adults). The results, which as expected revealed multisensory facilitation, provided a rapid and a highly sensitive measure of isolated proprioceptive accuracy. In the second experiment, we presented the virtual target only briefly and showed that VR can be used as an efficient and robust measurement of spatial memory (n = 18, healthy young adults). Finally, to assess the feasibility of using VR to study perception and action in populations with physical disabilities, we showed that the results from the visual-proprioceptive task generalize to two patients with recent cerebellar stroke. Overall, we show that VR coupled with hand-tracking offers an efficient and adaptable way to study human perception and action.

Motor skills predict adaptive behavior in autistic children and adolescents

It is well-documented that intelligence quotient (IQ) is a poor predictor of adaptive behavior scores in autism, with autistic children having lower adaptive behavior scores than would be predicted based on their IQ scores. Differences in motor skills may explain the variability in their adaptive behavior scores. The current study examined how motor skills might explain autistic individuals' low adaptive behavior scores and which individual components of IQ (i.e., verbal comprehension and perceptual reasoning) and motor skills (i.e., manual dexterity, aiming and catching, and balance) may drive this effect. We examined the associations between IQ, motor skills, calibrated severity, and adaptive behavior scores in 45 autistic children and adolescents. Using a t-test, we found a significant difference (p <0.001) between full-scale IQ and adaptive behavior scores, indicating that our participants' adaptive behavior scores were lower than would be expected given their full-scale IQ. Using a linear regression, we investigated whether motor skills predicted adaptive behavior in autistic children and adolescents and found that motor skills scores were associated with adaptive behavior scores (p = 0.022). To further investigate these associations, we used another linear regression to examine how individual components of IQ and motor skills predicted adaptive behavior scores in autistic children and adolescents. Our results indicated that manual dexterity scores were associated with adaptive behavior scores (p = 0.036). These findings clearly illustrate the need for further understanding of autistic individuals' difficulties with adaptive behavior and the potential role of motor skill difficulties that may underlie these difficulties. LAY SUMMARY: Autistic children have lower adaptive behavior scores (e.g., daily living skills, social skills, communication) than intelligence scores (e.g., verbal and perceptual skills) along with difficulties with motor skills. Motor skills may explain the gap between adaptive behavior and intelligence. We found motor skills were associated with adaptive behavior in autistic children and adolescents. In particular, hand coordination was associated with adaptive behavior. We need to better understand how autistic individuals' motor skills impact their adaptive behavior to provide effective supports.