A further study of relations between motor impairment and social communication, cognitive, language, functional impairments, and repetitive behavior severity in children with ASD using the SPARK study dataset

Abstract

Motor impairments are pervasive and persistent in children with autism spectrum disorder (ASD) throughout childhood and adolescence. Based on recent studies examining motor impairments in children with ASD between 5 and 15 years (i.e., SPARK study sample), 87-88% of this population is at-risk for a motor impairment, these problems persisted until 15 years, and related to their core (social communication skills and repetitive behaviors [RBs]) and comorbid (language, cognitive, and functional) impairments. Persistent motor impairments extending into adolescence/adulthood could negatively impact their independent daily living skills, physical fitness/activity levels, and physical/mental health. While multiple studies have examined relations between motor dimensions and core/comorbid impairments in young children with ASD, few studies have examined such relations in school-age children/adolescents with ASD. This paper conducts a further multidimensional study of which motor domains (i.e., gross-motor including visuo-motor or multilimb coordination/planning, fine motor [FM] or general coordination [GC] skills) best distinguish subgroups of school-age children/adolescents with ASD and help predict core and comorbid impairments after accounting for age and sex. Visuomotor, FM and certain GC skills were better at explaining variations in/predicting social communication impairments whereas FM skills were slightly better at explaining variations in/predicting RB severity. Multilimb coordination/planning and FM skills explained variations in/predicted cognitive delays whereas visuomotor and FM skills explained variations in and better predicted language delays. All three motor dimensions explained variations in/predicted functional delays. This study provides further evidence for inclusion of motor impairments within the ASD definition (criteria or specifiers). LAY SUMMARY: Gross-motor skills were related to social communication and functional delays of children with ASD (visuomotor skills related to language delays and multilimb coordination/planning skills related to cognitive delays). Fine-motor skills were related to repetitive behavior severity, language, cognitive, and functional delays in ASD. Diagnosticians should recommend systematic motor screening, further evaluations, and treatments for children at-risk for and diagnosed with ASD. Motor advocacy and enhanced public/clinical community awareness is needed to fulfill the unmet motor needs of children with ASD.

Keywords: language; motor (control, system); phenotype; restricted/repetitive behaviors; social cognition.

Figure 1:

DCD-Q total, standard subdomain (CDM, FM, GC), and factor analysis-based subdomain (CDM1, CDM2, FM, GC1, GC2) scores as a function of SCI, RB severity, cognitive, language, and functional impairment categories (C1 to C5) in children with ASD. Note that FM subplot is the same for the standard subdomains and the factor analysis-based subdomains. The total and standard subdomain subplots are taken from Bhat, 2021. CDM: Control During Movement, FM: Fine Motor, GC: General Coordination.

Figure 2:

Effect sizes for DCD-Q total score, standard subdomains (CDM, FM, GC), and factor analysis-based subdomains (CDM1, CDM2, FM, GC1, GC2). Horizontal dashed lines are added to illustrate high effect sizes (≥0.8 or ≤−0.8). CDM: Control During Movement, FM: Fine Motor, GC: General Coordination.

Figure 3:

Radar chart showing the effect sizes for DCD-Q total score and factor analysis-based subdomains (CDM1, CDM2, FM, GC1, GC2) to compare effects across impairments/delays. CDM: Control During Movement, FM: Fine Motor, GC: General Coordination.