Gross motor skills are related to postural stability and age in children with autism spectrum disorder

Motor skill and postural stability deficits are commonly reported for children with autism spectrum disorder (ASD), however the relationship between these variables is not well established. We explored the relationship between motor skills, postural stability, restricted and repetitive patterns of behavior, diagnosis, age, and sex. Children (11 with and 11 without ASD), 5–12 years of age, participated in the study. The Test of Gross Motor Development-3 (TGMD-3) was used to assess fundamental motor skills. Postural sway was measured on a force plate during quiet standing on a solid and compliant surface. Center of pressure was calculated and used to compute sway area. Linear regression analysis showed that sway area on a solid surface, age, and diagnosis were significant predictors of motor skill performance (R² = .854). Severity of ASD, as assessed by the Repetitive Behavior Scale-Revised (RBS-R), was not predictive of motor skills. Children with ASD exhibited deficits in postural stability compared to children without ASD. Postural stability appears to influence the ability of children to perform gross motor skills. However, the RBS-R does not seem to be a useful tool for identifying those children with ASD who exhibit the greatest deficits in motor skills.     

Predicting the rate of language development from early motor skills in at-risk infants who develop autism spectrum disorder

The aim of the current paper was to use data from a prospective study to assess the impact of early motor skills on the rate of language development in infants with an older sibling with autism spectrum disorder (ASD), who are at increased risk of developing ASD themselves. Infants were tested prospectively at four points (7, 14, 24 and 36 months), and were assessed for ASD at the last visit. Latent growth curve analysis was used to model rate of language development using the Vineland Adaptive Behavior Scales between 7–36 months in infants at high and low familial risk for ASD. Motor scores from the Mullen Scales of Early Learning at 7 months were used as predictors of language growth. Gross Motor scores predicted the subsequent rate of expressive, but not receptive, language development in at-risk siblings who were later diagnosed with ASD. Although the pattern was similar for fine motor skills, the relationship did not reach significance. It seems that early motor delay impacts the rate of development of expressive language, and this may be of particular importance to infants at increased risk of developing ASD.     

An investigation of upper limb motor function in high functioning autism and Asperger's disorder using a repetitive Fitts’ aiming task

There is now a growing body of research examining movement difficulties in children diagnosed with high functioning autism (HFA) and Asperger's disorder (AD). Despite this, few studies have investigated the kinematic components of movement that may be disrupted in children diagnosed with these disorders. The current study investigated rapid aiming movements in 19 individuals diagnosed with HFA, 20 individuals diagnosed with AD and 18 typically developing (TD) controls. A novel touchscreen version of a Fitts’ aiming task was administered that required participants to make 10 reciprocal aiming movements between targets. Task difficulty was manipulated by varying the size and distance between targets. Movement time in the HFA and AD groups was comparable to TD controls. Children with HFA displayed more constant and variable error across repeated aiming attempts compared to the TD group that may be attributed to deficits in feedforward online refinement of movement. These findings are in accordance with previous gait, ocular motor, upper limb and neuroimaging studies that suggest that the cerebellum may underlie movement disturbance in individuals diagnosed with HFA. Additionally, differences in the nature of upper limb motor disturbance in HFA may serve as a useful future adjunct to clinical measures.     

Nature of motor impairments in autism spectrum disorder: A comparison with developmental coordination disorder

Introduction: Several authors have suggested the existence of motor disorders associated with developmental coordination disorder (DCD) in individuals with autism spectrum disorder (ASD). However, there are few comparative studies of psychomotor profiles that include assessments of neurological soft signs in children with ASD or DCD. We used a neuropsychomotor assessment for children with ASD from a standardized neurodevelopmental examination to understand the nature of the difficulties these children encounter. To uncover the differences and similarities in psychomotor profiles, we compared the profiles of children with ASD with those of children with DCD and focused on two recently described DCD subgroups: visuospatial–constructional (VSC) and mixed (MX).

Methods: We compared 18 children with ASD and 58 children with DCD (33 with VSC-DCD and 25 with MX-DCD) who were assessed with a battery of French-language tests (the NP-MOT) to evaluate the neuropsychomotor functions associated with visual perception and visual–spatial–motor structuring.

Results: Although there were similarities between the profiles of children with ASD and those with DCD (VSC-DCD or MX-DCD), these similarities were not associated with the predictive diagnostic markers that characterized subtypes of DCD. Instead, many variables (visuospatial–motor structuration, synkinetic movements, dynamic balance, manual dexterity, coordination, praxis, bodily spatial integration, and digital perception) differed among the three groups; the best performance was observed in the children with ASD.

Conclusion: The neuropsychomotor profiles of children with ASD and those with VSC-DCD or MX-DCD differed, and these differences are discussed. Our results highlight that impairments of ASD are specific about lateralization disturbances and support the hypothesis of proprioceptive impairment due to visual fixation problems influenced by muscular tone in relation to the subcortical and cortical structures and possible interhemispheric disorder. Thus, some neuropsychomotor functions that underpin both gestures and a set of motor skills are affected.     

Prevalence of motor impairment in autism spectrum disorders

Autism spectrum disorders (ASD) are manifest as impairments in social interaction, language and speech development, and the appearance of repetitive behaviors with restricted interests. Motor impairments in individuals with ASD have been categorized as "associated symptoms". The objective of this study was to describe the prevalence of motor deficits in ASD. Specifically, using retrospective clinical record review, we report the prevalence of hypotonia, motor apraxia, reduced ankle mobility, history of gross motor delay, and toe-walking, as well as the improvement of these symptoms with age, in a cohort of 154 children with ASD. The possible association of motor deficits with epilepsy or developmental regression was also assessed. To address whether the motor deficits in children with ASD were properly identified and treated, we evaluated whether the children with the motor deficits were more likely to receive physical and/or occupational therapies as compared to the children with ASD who did not show motor deficits. Hypotonia was the most common motor symptom in our ASD cohort (51%) and this appeared to improve over time, as suggested by the significant reduction in prevalence in older children (p=0.002). Likewise, motor apraxia (34%) showed a tendency to be more prevalent among younger children as compared with older children (p=0.06). Historical intermittent toe-walking was found in 19% of children while reduced ankle mobility was a rare occurrence. Gross motor delay was reported in 9% of children, all of whom gained motor independence by the time of examination. Except for gross motor delay, ASD children with fine motor deficits were not more likely to receive interventional services, as compared with ASD children without the motor deficits. The results suggest that fine motor control and programming deficits are common co-occurrence of children with ASD in this cohort. The reduced prevalence of these motor deficits in older children suggests improvement over time, whether through natural progression, results of interventional therapy, or the combination of the two. However, ASD children with the motor deficits were not more likely to receive service than those without the motor deficits.     

Methodological considerations in the use of standardized motor assessment tools for children with autism spectrum disorder: A scoping review

BackgroundThis scoping review identified methodological parameters affecting evaluation when administering standardized motor assessment tools among children with autism spectrum disorder (ASD).MethodPubMed, CINAHL, PsycINFO, Scopus, ERIC and Web of Science were searched for English-language articles published 1/1990–8/2022. Studies of children with ASD, 3–18-years old, using performance-based standardized motor assessment tools, were included. ASD sample characteristics, enrollment criteria, accommodations and missing motor outcome data were synthesized.ResultsAmong 5,432 references, 180 studies using 11 assessments were included. The most frequently used tools were the Movement Assessment Battery for Children, Bruininks-Oseretsky Test of Motor Proficiency and the Test of Gross Motor Development. Large-scale studies were lacking, and girls underrepresented. Low cognitive level was an exclusion criterion explicitly or as a related criterion in 87 (48%) studies. Behavioral issues were noted anecdotally. Methodological detail varied, particularly regarding missing data, administrators’ professions, training and inter-rater reliability. Seventy-four studies reported a total of 197 accommodations, related mainly to modifications of the tasks, accommodations to the testing procedure and changes in the physical setting in which the test was conducted.ConclusionsThe findings, building on previous reports, indicate that children and adolescents with ASD cannot be approached uniformly over the entire spectrum of intelligence (IQ) and behavioral profiles in motor assessments. Administration challenges may stem from ASD characteristics beyond cognitive ability. Inconsistency relating to the IQ variable and incomplete methodological reports continue to be obstacles to comparative conclusions. ASD-specific versions of the tools with a supplementary report, describing cooperation, off-task behaviors and engagement, and combining several tools are recommended. This review could inform development of guidelines regarding motor assessments for children with ASD.     

Visual feedback increases postural stability in children with autism spectrum disorder

Autism spectrum disorders (ASD) are often associated with poor motor control, which depends greatly on postural stability. Firstly, this study examined postural stability in young children with ASD, as little is known about early postural skills in this population. Children with ASD are known to depend considerably on visual cues when maintaining balance. We therefore wished to explore whether visual stimuli would in turn improve postural stability. We recruited 18 children with ASD (aged 6–11) and also 12 age-matched typically developing (TD) children. We measured their baseline postural stability and their ability to maintain balance when provided contingent visual feedback of the movements of their center of pressure. Postural performances were measured with a force platform. Baseline postural stability of children with ASD was significantly reduced compared to TD children, as indicated by higher sway scores. When provided visual feedback, children with ASD improved their balance significantly. We conclude that although deficient postural control in ASD is present in childhood, this may be improved in facilitating settings where children with ASD can rely on visual cues.     

A novel stop-gain CUL3 mutation in a Japanese patient with autism spectrum disorder

BackgroundCUL3 encodes cullin-3, a core component of a ubiquitin E3 ligase. CUL3 mutations have recently been associated with autism spectrum disorder (ASD); however, the detailed clinical courses have been described in only a limited number of patients with CUL3 mutations and neurodevelopmental diseases, including ASD.Case reportA 21-month-old Japanese girl presented with febrile status epilepticus and thereafter exhibited developmental regression, including loss of her verbal ability, eye contact, and skills in activities of daily living. Trio-based exome sequencing identified a de novo two-base insertion in CUL3, c.1758_1759insTG, p.(Thr587*).ConclusionWe report a case of a patient with ASD and a stop-gain CUL3 variant. Screening of CUL3 variants is worth considering for patients with ASD, especially those with Rett-like developmental regression.     

An exploration of symmetry in early autism spectrum disorders: analysis of lying

Background: Early identification of children with autism spectrum disorders (ASD) is recognized as a critical aspect of their medical management and treatment. Movement disorders are considered one of the first signs which probably precede social or linguistic abnormalities. Objectives: to verify, through observational methods, the possibility of distinguishing infants with ASD from infants with typical development or with mental retardation by movement. Methods: The Eshkol-Wachman movement analysis system, which analyses static symmetry (SS) and dynamic symmetry (DS) during lying, was applied to retrospective home videos regarding the first 5 months of life of children with ASD (n = 18), typical development (n = 18), or developmental delay (n = 12). Results: Significant differences between ASD and the two control groups were found for both SS (p < .001) and DS (p < .01). Within ASD two groups of infants could be differentiated on the basis of the higher (HLS) or the lower (LLS) levels of symmetry. Early onset ASD are more likely to belong to the LLS group. Conclusion: We suggest that motor functioning may define specific subgroups of early ASD which are related to different pathways to the syndrome. LLS could be used as an early indicator of potential autism since the first months of life.     

Alternative treatments for autism: Prevalence and predictors

Autism is a heterogeneous neurodevelopmental disorder for which a large variety of treatments are offered, including alternative treatments. Vaccine-related treatments (treatments falsely claiming to cure autism by addressing its alleged cause: routine childhood vaccines such as MMR) continue to be offered worldwide, despite widespread evidence against the effectiveness and even possible harm related to these treatments. We analysed the use of alternative treatments in two studies: a survey study (N = 1989, autistic adults and parents/legal representatives of individuals with autism) and a clinical care study (N = 4520, patient files from a treatment center for autism). Both studies found a relatively high frequency of alternative treatments (23.0–30.7%) – in children even 46.4% -, mostly in combination with mainstream treatment. In the survey study vaccine-related treatments were used by 3.2% of all individuals with autism (and 6.7% of autistic children), and alternative treatment use was predicted by co-occurring diagnoses, younger age of diagnosis and mainstream treatment use. In the clinical care study, patients who had received treatment from a homeo-/osteopath more often had highly educated parents from Dutch/Western background and were more often enrolled in special education. Alternative treatments are widely used and should be included in treatment guidelines. Parents, practitioners and individuals with autism should be both advised and warned about the benefits and risks of these treatments. More research is needed to better understand the choice for and effect of alternative treatments for autism, and mainstream care should be improved.     

Modulation effects of the intact motor skills on the relationship between social skills and motion perceptions in children with autism spectrum disorder: A pilot study

BackgroundAn individual with autism spectrum disorder (ASD) has social skill, motor skill, and motion perception deficits. However, the relationship among them was not clarified. Therefore, this study aimed to evaluate the effects of motor skills on social skills and motion perception.MethodsFive typically developed children and fourteen children with ASD participated in our study. The N200 component, a brain activity indicating motion perception, was induced in mid-temporal (MT/V5) brain area by watching a random dot kinematograph, and was recorded using a scalp electroencephalogram. Furthermore, the social responsiveness scale (SRS) indicating the social skill deficit, the developmental coordination disorder questionnaire (DCDQ) estimating the developmental coordination disorder (DCD), and the movement assessment battery for children second edition (MABC-2) indicating motor skills were recorded in the children with ASD. A hierarchical multiple regression analysis was conducted to examine the modulation effects of motor skills on the relationship between social skills and motion perception. The dependent variable was the N200 latency, and the independent variables were SRS, MABC-2, and combined MABC-2 and SRS.ResultsThe N200 latency was more delayed in children with ASD relative that in typically developed children. Intact balance ability modulated the relationship between social skills and N200 latency in children with ASD. Within the high balance ability, when the social skills worsened, the N200 latency was shortened.ConclusionsThis is the first report that intact motor skills could modulate the relationship between social skills and motion perception.     

Effortful control in typically developing boys and in boys with ADHD or autism spectrum disorder

Despite increased interest in the role of effortful control (EC) in developmental disorders, few studies have focused on EC in autism spectrum disorders (ASD) and no study so far has directly compared children with ASD and children with ADHD. A first aim of this study was to investigate whether typically developing (TD) boys, boys with ADHD and boys with ASD can be differentiated based on EC levels. A second aim was to evaluate the relationship between EC and symptoms of ADHD and ASD. We assessed EC in 27 TD boys, 27 boys with ADHD and 27 boys with ASD (age 10-15) using different EC questionnaires. Clinical groups scored lower than the TD group on all EC total scales, but could only be differentiated from each other by means of self-reported persistence, impulsivity and activation control. Our data suggest that although EC is useful in differentiating TD boys from clinical groups, it is less efficient in distinguishing ADHD from ASD. Also, results suggest that EC plays a role in the manifestation of symptoms of both ADHD and ASD and that high levels of EC enable children to function more adequate in daily situations.     

Sexuality in a community based sample of adults with autism spectrum disorder

Few studies have examined the sexual attitudes and behaviours of individuals with high functioning autism spectrum disorders (ASDs) living in community settings. A total of 82 (55 female and 17 male) adults with autism were contrasted with 282 members of the general population on their responses to an online survey of sexual knowledge and experiences. Findings revealed that individuals with ASD display an interest in sex and engage in sexual behaviours and showed no significant differences in breadth and strength of sexual behaviours and comprehension of sexual language when contrasted with non-ASD participants. However, despite these similarities, a higher rate of asexuality was found among individuals with ASD. In addition, the results of the current study indicated that females with ASD show a significantly lower degree of heterosexuality when compared to males with ASD. The results also suggested a higher degree of homosexuality among females with ASD although this effect did not reach significance.     

Modulation of motor cortical excitability by continuous theta-burst stimulation in adults with autism spectrum disorder

ObjectiveTo test whether change in motor evoked potential (ΔMEP) induced by continuous theta-burst stimulation (cTBS) of motor cortex (M1) distinguishes adults with autism spectrum disorder (ASD) from neurotypicals, and to explore the contribution of two common polymorphisms related to neuroplasticity.Methods44 adult neurotypical (NT) participants (age 21–65, 34 males) and 19 adults with ASD (age 21–58, 17 males) prospectively underwent M1 cTBS. Their data were combined with previously obtained results from 35 NT and 35 ASD adults.ResultsΔMEP at 15 minutes post-cTBS (T15) was a significant predictor of diagnosis (p = 0.04) in the present sample (n=63). T15 remained a significant predictor in a larger sample (n=91) and when partially imputed based on T10–T20 from a yet-greater sample (N=133). T15 also remained a significant predictor of diagnosis among brain-derived neurotrophic factor (BDNF) Met+ and apolipoprotein E (APOE) ε4− subjects (p’s < 0.05), but not among Met− or ε4+ subjects (p’s > 0.19).ConclusionsΔMEP at T15 post-cTBS is a significant biomarker for adults with ASD, and its utility is modulated by BDNF and APOE polymorphisms.SignificanceM1 cTBS response is a physiologic biomarker for adults with ASD in large samples, and controlling for BDNF and APOE polymorphisms can improve its diagnostic utility.     

Genome-wide association scan of korean autism spectrum disorders with language delay: a preliminary study

Objective

Communication problems are a prevalent symptom of autism spectrum disorders (ASDs), which have a genetic background. Although several genome-wide studies on ASD have suggested a number of candidate genes, few studies have reported the association or linkage of specific endophenotypes to ASDs.

Methods

Forty-two Korean ASD patients who showed a language delay were enrolled in this study with their parents. We performed a genome-wide scan by using the Affymetrix SNP Array 5.0 platform to identify candidate genes responsible for language delay in ASDs.

Results

We detected candidate single-nucleotide polymorphisms (SNPs) in chromosome 11, rs11212733 (p-value=9.76×10^-6) and rs7125479 (p-value=1.48×10^-4), as a marker of language delay in ASD using the transmission disequilibrium test and multifactor dimensionality reduction test.

Conclusion

Although our results suggest that several SNPs are associated with language delay in ASD, rs11212733 we were not able to observe any significant results after correction of multiple comparisons. This may imply that more samples may be required to identify genes associated with language delay in ASD.     

Characteristics of narrative language in autism spectrum disorder: Evidence from the Finnish

This study examined linguistic and pragmatic aspects of narrative abilities of children with autism spectrum disorder (ASD), which have not been studied thoroughly and not at all in Finnish. Sixteen five- to ten-year-old Finnish high-functioning children with ASD (mean age 7;7 years) and 16 age-matched typically developing children (mean age 7;5 years) participated in this study. Children's picture-based narrations were analyzed for narrative productivity, syntactic complexity, referential accuracy, event content, use of additional and extraneous information, mental state expressions, and narrative comprehension. Several linguistic- and pragmatic-based measures were used in order to gain a comprehensive picture of strengths and weaknesses that children with ASD might show in storytelling. The use of linguistic structure, referential accuracy and mental state expressions was similar between the groups. However, children with ASD showed difficulties in establishing informative story content, making inferences from story events and an ability not to include extraneous information into their stories. Therefore, the problems seen in their narrative language use can be described as being related to pragmatic aspects of narration.     

Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: perspective from a developing country

Psychopharmacotherapy can be an effective part of the treatment for individuals with autism spectrum disorders (ASDs). However debate continues over the potential benefits and costs of these treatments; additionally little is known about the pattern of psychotropic medication use in developing countries. We aimed to survey the use of psychotropic medication, their subcategories and its associations among a representative local sample of 345 Iranian pupils with ASDs. All required information about demographics as well as clinical and medication history of children was collected through interviews with the families. Overall, 80% of participants were currently using at least one psychotropic medication while, and up to 97% of the sample had at least one psychotropic medication claim during the last year. Antipsychotics were the most frequent medications (57.4%) while antidepressants were used by only a small proportion of participants (8.7%). Further analysis revealed no significant association between any psychotropic medication use on one hand and clinical and demographic characteristics on the other hand. Time differences, cross cultural variations, and also cost and availability of treatment options in developing countries are discussed as possible explanations for different patterns and more than expected rate of psychotropic medication use in pupils with ASD.     

Weight status in Iranian children with autism spectrum disorders: Investigation of underweight, overweight and obesity

The purpose of this study was to survey the weight status of children and adolescents with autism spectrum disorders (ASDs) in Iranian pupils and further to investigate the most likely associated factors such as demographics, autism severity and medications. The survey was designed to provide a random sample of 113 children and adolescents (boys = 90, girls = 23) aged 7-14 years old attending autism-specific schools in Tehran in 2010. The findings revealed that 50.4% of these young children were in the limits of normal weight, but 8.7% were underweight, 13.3% were overweight, 11.5% were obese, and 15.9% were severely obese. There were significant associations between obesity and poverty level, age, sex and socioeconomic state. We conclude that with increase in the prevalence of ASD, there was found a growing rate of obesity in these children.     

Too much or too little: Hyper- and hypo-reactivity in high-functioning autism spectrum conditions

Abstract

Background Sensory reactivity in people with autism spectrum conditions (ASC) has been found to differ in comparison to reactivity in people without ASC. In this study sensory experiences of high-functioning individuals with ASC were explored and described.

Method Interview data from 15 participants with a diagnosis of ASC were analysed by content analysis.

Results Seven aspects of sensory experiences were identified: Being hyper- and hypo-reactive, reacting to general overload, having strong stimuli preferences, managing attentiveness to stimuli, managing sensory/motor stimuli, and dealing with consequences of sensory reactions in daily life.

Conclusions The categorisation of sensory reactivity in this study can guide clinicians on how to pose questions about sensory issues to individuals with ASC. The assessment of spectrum-specific sensory experiences in high-functioning ASC and their association with other social and nonsocial features of ASC are goals for further research.     

Spatial and temporal analysis of postural control in children with high functioning Autism Spectrum Disorder

BackgroundChildren with autism spectrum disorders (ASD) have poor postural stability. The objective of our study was to explore further postural capabilities in ASD children by measuring spatial as well as temporal displacement of the center of pressure using wavelet analysis.MethodThirty children with ASD (12.1 ± 2.9 years) and 30 sex-, age- and IQ-matched typically developing children participated in the study. We recorded postural control using Multitest, also called Balance Quest, Equilibre from Framiral^® in three viewing conditions (eyes open, eyes closed and with perturbed vision) and in two postural conditions (stable and unstable).ResultsOur results show that children with ASD displayed a deficit in postural stability in comparison with typically developing children, especially when sensory inputs are not all available.ConclusionSuch poor postural control in children with ASD could be due to both an impairment in using sensorial inputs appropriately and a deficit in the ability to compensate for sensorial changes.