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. 2025 Apr 14;179(7):756-764.
doi: 10.1001/jamapediatrics.2025.0216. Online ahead of print.

Prevalence of Motor Milestone Delays in Autistic Children

Olivia M Pokoski  1   2 , Sarah M Furnier  1   2 , Ronald E Gangnon  1   3 , Ellen M Howerton  4 , Anne V Kirby  5 , Tyra Protho  6 , Marin L Schweizer  7 , Brittany G Travers  2   8 , Maureen S Durkin  1   2
Affiliations

Prevalence of Motor Milestone Delays in Autistic Children

Olivia M Pokoski et al. JAMA Pediatr. .

Abstract

Importance: Prior literature has explored the prevalence of motor impairments in autistic individuals, but estimates come from clinical, convenience, or small samples, limiting generalizability. Better understanding of the frequency of motor milestone delays in autistic individuals could improve early identification and subsequently lead to earlier intervention and better developmental outcomes.

Objective: To determine the prevalence of motor milestone delays in a population-based sample of 8-year-old autistic children and to evaluate if having motor milestone delays is associated with an earlier age at autism evaluation or diagnosis.

Design, setting, and participants: This cross-sectional study of autistic 8-year-old children was conducted using Autism and Developmental Disabilities Monitoring (ADDM) Network data between surveillance years 2000 and 2016. ADDM Network data are population based and are drawn from 17 sites across the US. Data were analyzed from October 2023 to August 2024.

Exposure: Binary indicator of motor milestone delays documented in health or educational records.

Main outcomes and measures: The primary outcome was the prevalence of motor milestone delays among autistic 8-year-old children. Associations between motor milestone delays and age at autism evaluation or diagnosis were evaluated using linear regression. Covariates included study site, surveillance year, the number of autism discriminators, intellectual disability, child sex, and child race and ethnicity.

Results: Among 32 850 children aged 8 years identified with autism by active surveillance, 23 481 children (71.5%) met criteria for motor milestone delays. A total of 5973 children (18.2%) were female. In linear regression models, children with motor milestone delays were evaluated for autism significantly earlier (mean age, 43.65 months; 95% CI, 43.38-43.91) than children without motor milestone delays (mean age, 51.64 months; 95% CI, 51.22-52.06). After stratifying by the co-occurrence of intellectual disability (ID), children with motor milestone delays were evaluated for autism earlier than those without motor milestone delays, regardless of ID.

Conclusions and relevance: This cross-sectional study estimates the prevalence of motor milestone delays among autistic 8-year-old children and highlights the association between these delays and an earlier autism evaluation, even in children without co-occurring ID. Early identification of autism is a public health priority, and assessing motor milestone delays, particularly in children with an increased likelihood of being autistic, may facilitate an earlier autism evaluation, leading to more timely interventions and better developmental outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Pokoski, Dr Furnier, and Dr Durkin reported grants from the US Centers for Disease Control and Prevention (CDC) Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development during the conduct of the study. Dr Gangnon reported grants from US National Institutes of Health during the conduct of the study. Dr Kirby reported grants from the CDC during the conduct of the study. Dr Schweizer reported personal fees from 3M outside the submitted work. No other disclosures were reported.

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