Gross motor impairment and its relation to social skills in autism spectrum disorder: A systematic review and two meta-analyses

Abstract

Gross motor ability is associated with profound differences in how children experience and interact with their social world. A rapidly growing literature on motor development in autism spectrum disorder (ASD) indicates that autistic individuals exhibit impairment in gross motor skills. However, due to substantial heterogeneity across studies, it remains unclear which gross motor skills are impaired in ASD, when and for whom these differences emerge, and whether motor and social impairments are related. The present article addressed these questions by synthesizing research on gross motor skills in ASD in two separate meta-analyses. The first examined gross motor deficits in ASD compared to neurotypical (NT) controls, aggregating data from 114 studies representing 6,423 autistic and 2,941 NT individuals. Results demonstrated a significant overall deficit in gross motor skills in ASD (Hedges' g = -1.04) that was robust to methodological and phenotypic variation and was significant at every level of the tested moderators. However, moderation analyses revealed that this deficit was most pronounced for object control skills (i.e., ball skills), clinical assessment measures, and movements of the upper extremities or the whole body. The second meta-analysis investigated whether gross motor and social skills are related in ASD, synthesizing data from 21 studies representing 654 autistic individuals. Findings revealed a modest but significant overall correlation between gross motor and social skills in ASD (r = 0.27). Collectively, results support the conclusion that motor deficits are tied to the core symptoms of ASD. Further research is needed to test the causality and directionality of this relationship. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Figure 1

Histogram of the Year of Publication of the Articles Included in This Meta-Analysis

Figure 2

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart of the Search Process and Exclusion of Papers Note. ASD = autism spectrum disorder; NT = neurotypical. See the online article for the color version of this figure.

Figure 3

Forest Plot of Study-Level Aggregated Mean Difference Effects Included in Study 1

Figure 4

Plot of the Distribution of Group Difference Effect Sizes for Each Gross Motor Skill Domain Note. Aggregate effect sizes at the study level were used to produce this plot. Violin plots represent the smoothed distribution density of effects in each category.

Figure 5

Plot of the Distribution of Group Difference Effect Sizes for Each Gross Motor Muscle Group Note. Aggregate effect sizes at the study level were used to produce this plot. Violin plots represent the smoothed distribution density of effects in each category. “Whole” represents gross motor behaviors that recruit muscle groups across the whole body (e.g., balancing, jumping jacks); “lower” represents gross motor behaviors that recruit the lower extremities (e.g., kicking a ball); “upper” represents gross motor behaviors that recruit the upper extremities (e.g., reaching toward an object).

Figure 6

Plot of the Distribution of Group Difference Effect Sizes for Each Gross Motor Measurement Modality

Note. Aggregate effect sizes at the study level were used to produce this plot. Violin plots represent the smoothed distribution density of effects in each category.

Figure 7

Funnel Plot of All Aggregate Study-Level Group Difference Effect Sizes by Standard Error for Articles Included in Study 1

Figure 8

Forest Plot of Study-Level Aggregated Correlation Coefficients Included in Study 2

Figure 9

Funnel Plot of All Aggregate Study-Level Fisher’s Z-Transformed Correlation Effect Sizes by Standard Error for Articles Included in Study 2