Motor skills of toddlers with autism spectrum disorders

Spontaneous Calcium Transients Recorded from Striatal Astrocytes in a Preclinical Model of Autism

Autism spectrum disorder (ASD) is known as a group of neurodevelopmental conditions including stereotyped and repetitive behaviors, besides social and sensorimotor deficits. Anatomical and functional evidence indicates atypical maturation of the striatum. Astrocytes regulate the maturation and plasticity of synaptic circuits, and impaired calcium signaling is associated with repetitive behaviors and atypical social interaction. Spontaneous calcium transients (SCT) recorded in the striatal astrocytes of the rat were investigated in the preclinical model of ASD by prenatal exposure to valproic acid (VPA). Our results showed sensorimotor delay, augmented glial fibrillary acidic protein -a typical intermediate filament protein expressed by astrocytes- and diminished expression of GABAA-ρ3 through development, and increased frequency of SCT with a reduced latency that resulted in a diminished amplitude in the VPA model. The convulsant picrotoxin, a GABAA (γ-aminobutyric acid type A) receptor antagonist, reduced the frequency of SCT in both experimental groups but rescued this parameter to control levels in the preclinical ASD model. The amplitude and latency of SCT were decreased by picrotoxin in both experimental groups. Nipecotic acid, a GABA uptake inhibitor, reduced the mean amplitude only for the control group. Nevertheless, nipecotic acid increased the frequency but diminished the latency in both experimental groups. Thus, we conclude that striatal astrocytes exhibit SCT modulated by GABAA-mediated signaling, and prenatal exposure to VPA disturbs this tuning.

Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review

Background

Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual's life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap.

Objective

This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta ("Forta"), as measured by progress toward skill acquisition within multiple focus areas (FAs).

Methods

Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25-40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13-22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house.

Results

Improved goal achievement success between weeks 1-20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045).

Conclusions

Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care.

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.

Cognitive behavioral phenotyping of DSCAM heterozygosity as a model for autism spectrum disorder

It is estimated that 1 in 36 children are affected by autism spectrum disorder (ASD) in the United States, which is nearly a twofold increase from a decade ago. Recent genetic studies have identified de novo loss-of-function (dnLoF) mutations in the Down Syndrome Cell Adhesion Molecule (DSCAM) as a strong risk factor for ASD. Previous research has shown that DSCAM ablation confers social interaction deficits and perseverative behaviors in mouse models. However, it remains unknown to what extent DSCAM underexpression captures the full range of behaviors, specifically cognitive phenotypes, presented in ASD. Here, we conducted a comprehensive cognitive behavioral phenotyping which revealed that loss of one copy of DSCAM, as in the DSCAM2J+/-, that is, DSCAM heterozygous mice, displayed hyperactivity, increased anxiety-like behavior, and motor coordination deficits. Additionally, hippocampal-dependent learning and memory was affected, including impairments in working memory, long-term memory, and contextual fear learning. Interestingly, implicit learning processes remained intact. Therefore, DSCAM LoF produces autistic-like behaviors that are similar to those observed in human cases of ASD. These findings further support a role for DSCAM dnLoF mutations in ASD and suggest DSCAM2J+/- as a suitable model for ASD research.

Validating motor delays across the developmental coordination disorder-questionnaire and the Vineland adaptive behavior scales (VABS) in children with autism spectrum disorderASD: A SPARK dataset analysis

Motor delays in children with autism spectrum disorder (ASD) are being increasingly recognized using a brief screening tool, called the Developmental Coordination Disorder-Questionnaire (DCD-Q). Further validation of these motor delays using a more robust normed, developmental measure is clearly warranted. In this analysis, a nationally representative sample from the SPARK study was used wherein parents completed the DCD-Q and a more widely used developmental/adaptive functioning measure, called the Vineland Adaptive Behavior Scales (VABS); which comprises of various developmental domains including the motor domain (N = 2,644 completed the DCD-Q and VABS). Eighty two percent children with ASD had a motor delay based on their DCD-Q scores whereas 77% children with ASD had a motor delay based on their VABS motor domain scores. Approximately 70% children with ASD had concurrent motor delay on the DCD-Q and the VABS (i.e., positive predictive value of DCD-Q). Furthermore, there was 81.2% accuracy in reporting a risk/no risk of motor delay across both measures. Overall, these statistics align with the recent reports on proportions of children with ASD having motor delays. Parents of ~70% children with ASD are reporting motor delays that are corroborated across two different motor measures. This not only validates the motor delays reported based on the DCD-Q but also indicates the need for concurrent motor screening using both DCD-Q and VABS for better detection of motor delays in children with ASD. Only 10%-32% of the current SPARK sample received any physical or recreational therapies. This mismatch between presence of motor delays and the lack of access to motor services highlights the need for more motor intervention referrals for children with ASD.

The effectiveness of group interpersonal synchrony in young autistic adults' work environment: A mixed methods RCT study protocol

INTRODUCTION

Few autistic adults are able to integrate successfully into the world of work given their difficulties adapting to the social and stressful aspects of work environments. Interpersonal synchrony, when two or more individuals share body movements or sensations, is a powerful force that consolidates human groups while promoting the ability to self-regulate and cooperate with others. The abilities to self-regulate and cooperate are crucial for maintaining a calm and productive work environment. This study protocol outlines research that aims to assess the effects of group interpersonal synchrony on prosociality and work-related stress of young autistic adults in their work environment.

METHODS AND ANALYSIS

This mixed-methods randomized controlled trial will investigate two movement-based group synchronous and non-synchronous intervention conditions. The sample will be composed of young adults enrolled in an innovative Israeli program designed to integrate cognitively-abled 18- to 25-year-old autistic adults into the Israeli army work force. The movement-based intervention sessions will take place in groups of 10-14 participants, once a week for 10 weeks. Questionnaires, behavioral collaborative tasks and semi-structured interviews will be conducted. Quantitative data will be collected for each participant at three points of time: before and after the intervention period, and 17 weeks after the end of the intervention. Qualitative data will be collected after the intervention period in interviews with the participants.

DISCUSSION

Little is known about interventions that promote successful integration into social and stressful work environments. The findings are likely to shed new light on the use of group interpersonal synchrony in autistic individuals at work.

TRIAL REGISTRATION

NCT05846308.

A systematic review and meta-analysis of the associations between motor milestone timing and motor development in neurodevelopmental conditions

Early motor skills may be important early markers of neurodevelopmental conditions or predictors of their later onset. To explore this, we conducted a systematic review and meta-analysis of infant motor skill assessments in those who go on to gain a clinical diagnosis of autism, attention deficit hyperactivity disorder (ADHD), schizophrenia, language conditions, tic disorders, or developmental coordination disorder (DCD). In total, 63 articles met inclusion criteria. Three three-level meta-analyses were run. Meta-analysis of milestone achievement in N= 21205 individuals revealed gross motor milestones were significantly delayed compared to controls (g= 0.53, p< 0.001). Subgroup analyses revealed autism (g= 0.63) and DCD (g= 0.53) had the highest magnitude delays. Specific delays were revealed for holding the head up (g= 0.21), sitting (g= 0.28), standing (g= 0.35), crawling (g= 0.19), and walking (g= 0.71). Meta-analyses of standardised motor skill measurements in N= 1976 individuals revealed reduced performance compared to controls in autism and language conditions (g= -0.54, p< 0.001). Together, these findings demonstrate delayed milestone attainment and motor impairments in early childhood in neurodevelopmental conditions.

Autistic Traits Associated with the Fragile X Premutation Allele: The Neurodevelopmental Profile

Although most individuals who carry the Fragile X premutation allele, defined as 55-200 CGG repeats on the X-linked FMR1 gene (Fragile X Messenger Ribonucleoprotein 1 gene), do not meet diagnostic criteria for autism spectrum disorder, there is a suggestion of increased behaviors associated with subtle autistic traits. More autism associated characteristics have been reported among adults than children. This may highlight a possible worsening developmental trajectory, variable findings due to research quality or differences in number of studies done in adults vs children, rather than true developmental changes. This review is designed to examine the neurodevelopmental profile associated with the premutation allele from a developmental perspective, focused on autistic traits.

Cognitive behavioral phenotyping of DSCAM heterozygosity as a model for autism spectrum disorder

It is estimated that 1 in 36 children are affected by autism spectrum disorder (ASD) in the United States, which is nearly a twofold increase from a decade ago. Recent genetic studies have identified de novo loss-of-function (dnLoF) mutations in the Down Syndrome Cell Adhesion Molecule (DSCAM) as a strong risk factor for ASD. Previous research has shown that DSCAM ablation confers social interaction deficits and perseverative behaviors in mouse models. However, it remains unknown to what extent DSCAM underexpression captures the full range of behaviors, specifically cognitive phenotypes, presented in ASD. Here, we conducted a comprehensive cognitive behavioral phenotyping which revealed that loss of one copy of DSCAM , as in the DSCAM 2J +/- mice, displayed hyperactivity, increased anxiety, and motor coordination impairments. Additionally, hippocampal-dependent learning and memory was affected, including working memory, long-term memory, and contextual fear learning. Interestingly, implicit learning processes remained intact. Therefore, DSCAM LoF produces autistic-like behaviors that are similar to human cases of ASD. These findings further support a role for DSCAM dnLoF mutations in ASD and suggest DSCAM 2J +/- as a suitable model for ASD research.

Summary Statement

Autism spectrum disorder represents a growing patient population. Loss of one copy of the DSCAM gene provides a promising mouse model that reproduces autistic-like behaviors for research and therapeutic testing.

The relationships between motor skills and executive functions in children with and without autism spectrum disorder

To date, information on associations between motor skills and executive functions (EF) in autistic children is limited. The purpose of this study was to compare motor skills and EF performance between autistic children and typically developing (TD) children and to examine the relationships between motor skills and EF in these two groups. Forty-eight autistic children and 48 TD children aged 6 to 12 years were recruited for this study. Motor skills were measured with the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2). EF was assessed with the Stroop Color and Word Test, the Wisconsin Card Sorting Task (WCST), and the Test of Attentional Performance: Go/No-go test. Independent sample t-tests were used to compare the BOT-2 scores and EF measures between autistic children and TD children. Pearson product-moment correlation and regressions were conducted to assess the relationships between the BOT-2 scores and the EF measures for each group. Results showed that autistic children scored significantly lower than TD children on all four BOT-2 composite scores and a total motor composite. Autistic children also demonstrated significantly lower levels of performance on all EF measures than TD children. Further, autistic children showed more significant associations between motor skills and EF than TD children, particularly pronounced in the domains of fine manual control and manual coordination to cognitive flexibility, as well as manual coordination and inhibitory control. Continued development of motor skills and EF in autistic children is important. The relationships between motor skills and EF were significant among autistic children, suggesting future research on promoting EF through motor skill interventions in autistic children is required.

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.

Effects of Motor Intervention Program on Academic Skills, Motor Skills and Social Skills in Children with Autism Spectrum Disorder

The aim of this study was to examine the effect of motor intervention program (MIP) on autistic index, pre-academic skills, motor skills and social skills of children with Autism Spectrum Disorder (ASD). The research group consisted of a total of 34 participants between the ages of 3-6, 17 in the control group (CG) and 17 in the experimental group (EG). EG participated in the motor intervention program for 60 min a day, 2 days a week for 12 weeks. In the study, the Gilliam Autistic Disorder Rating Scale-2-Turkish Version (GARS-2 TV), Peabody Motor Development Scale-2 (PMDS-2), Pre-Academic Skills Evaluation Form (PASAF) and Social Skills Evaluation System Preschool Teacher Form (SSRS-PTF) were used. The increase in all subtests and total scores of PASAF and posttest scores obtained from PMDS-2 were found to be higher in favor of the experimental group (p < 0.05). The decrease in the stereotype and social interaction scores of GARS-2 TV and the change in the cooperation, self-control and externalization sub-dimensions of SSRS-PTF were found to be statistically significant in favor of the EG group (p < 0.05). In conclusion, it was found that MIP applied to autistic children was effective on the development of motor skills, academic skills and social skills and decreased the level of autistic index. This result shows that MIP is an effective practice that provides a favorable environment for autistic young children to develop multiple skills.

A comparative study on fundamental movement skills among children with autism spectrum disorder and typically developing children aged 7-10

Background

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with unique differences in social interaction, communication, and a spectrum of behavioral characteristics. In the past, motor disturbance in individuals with ASD has not been considered a significant core deficit due to the predominant focus on sociability and communication issues. However, recent studies indicate that motor deficits are indeed associated with the fundamental symptoms of ASD. As there is limited research on the motor behavior of children with ASD, particularly in China, the objective of this study is to investigate the development of fundamental movement skills (FMS) in children with ASD and compare them to typically developing children.

Method

The study recruited 108 children with ASD (87 boys, 21 girls) aged 7-10 years from two special education rehabilitation centers in Wuhan, China. For comparison, a control group of 108 typically developing children, matched by age and gender, was randomly selected from three local primary schools. FMS were assessed using the Movement Assessment Battery for Children - Second Edition (MABC-2), which evaluates manual dexterity, aiming and catching, as well as static and dynamic balance. Group differences on MABC-2 percentile scores were analyzed using descriptive statistics and Mann-Whitney U test. Effect sizes were also calculated for practical significance.

Results

Findings from the study showed that a significant majority, around 80%, of children with ASD either displayed motor challenges or were at risk of developing such delays. When comparing to their typically developing peers, children with ASD scored notably lower in areas of manual dexterity, ball skills, and both static and dynamic balance (with all these findings being statistically significant at p < 0.001). Interestingly, gender did not show a significant influence on these results (p > 0.05).

Conclusion

In addition to addressing the other skill development areas outlined in the diagnostic manual for ASD, clinicians diagnosing and treating children with ASD should also assess the presence of motor skill development. For individuals with ASD who have co-existing motor difficulties, it is essential to offer evidence-based interventions tailored to their specific needs.

Receptive language and receptive-expressive discrepancy in minimally verbal autistic children and adolescents

Among the approximately one-third of autistic individuals who experience considerable challenges in acquiring spoken language and are minimally verbal (MV), relatively little is known about the range of their receptive language abilities. This study included 1579 MV autistic children and adolescents between 5 and 18 years of age drawn from the National Database for Autism Research and the SFARI Base data repository. MV autistic children and adolescents demonstrated significantly lower receptive language compared to the norms on standardized language assessment and parent report measures. Moreover, their receptive language gap widened with age. Overall, our sample demonstrated significantly better receptive than expressive language. However, at the individual level, only about 25% of MV autistic children and adolescents demonstrated significantly better receptive language relative to their minimal expressive levels. Social skills explained a significant proportion of the variance in parent-reported receptive language skills, while motor skills were the most significant predictor of greater receptive-expressive discrepancy. Findings from this study revealed the heterogeneous language profiles in MV autistic children and adolescents, underscoring the importance of individualizing interventions to match their different communication strengths and needs and integrating multiple interconnected areas to optimize their overall development of language comprehension, socialization, and general motor skills.

Association between motor skills and executive function of children with autism spectrum disorder in Taiwan and the United States

Objective

The purpose of this study was to examine the relationship between parent ratings of motor skills and executive function (EF) in children with autism spectrum disorder (ASD) in the United States and Taiwan.

Materials and method

One hundred and seventy-two parents/legal guardians of children (4-6 years and 11 months old) with ASD were recruited from two countries, Taiwan (n = 100) and the United States (n = 72). The parents or guardians of the child with ASD completed a questionnaire including demographic information, child's motor skills (using Children Activity Scale - Parents, ChAS-P), and child's EF (using Childhood Executive Functioning Inventory, CHEXI). A series of hierarchical multiple regressions were conducted to determine whether ChAS-P (total motor score, fine motor skills, and gross motor skill) was associated with CHEXI (total EF score, working memory, and inhibition), after controlling for covariates (i.e., age, gender, race, body mass index, whether children received physical activity or cognitive training, parental education level).

Results

Total motor skills, fine motor skills, and gross motor skills were significantly associated with EF in both working memory and inhibition as rated by parents in both countries (β = 0.21-0.57, p < 0.01), with the exception of a non-significant association between parent-rated total motor skills, fine motor skills, and gross motor skills, and inhibition among Taiwanese children with ASD. In addition, the associations between parent ratings of motor skills (i.e., fine motor and gross motor skills) and EF (i.e., working memory and inhibition) were similar between the two countries.

Conclusion

Positive associations with specific aspects of parent ratings of fine motor and gross motor skills and working memory and inhibition were found in children with ASD from both countries. These findings have implications for future interventions and programs focused on improving early motor skills and EF development for young children with ASD from Taiwan and the United States.

Trajectories of physical activity among autistic children and their caregivers: Outcomes of a virtual 1-year longitudinal intervention

BACKGROUND

Participation in regular physical activity (PA) is a critical component of overall well-being. However, opportunities to engage in health-enhancing PA for families who have an autistic child are relatively obsolete. A virtual PA intervention has the potential to address many participation barriers and represents a timely opportunity to promote positive trajectories of PA among vulnerable populations.

OBJECTIVE

To examine PA trajectories during a one-year virtual intervention for autistic children and their caregiver and to explore relationships in activity participation within child-caregiver dyads.

METHODS

Twenty-nine families, including autistic children and their caregiver participated in the full intervention. Caregivers completed questionnaires to measure PA behavior at baseline and four-month intervals throughout the intervention.

RESULTS

Reported PA significantly increased among autistic children and caregivers during the intervention. No association in PA was observed within dyads at baseline, but moderate relationships were observed during the intervention.

CONCLUSION

Findings demonstrate the initial effectiveness of a virtual PA intervention for autistic children and their caregiver.

Motor problems in autism: Co-occurrence or feature?

Motor features of autism have long been acknowledged by clinicians, researchers, and community stakeholders. Current DSM-5 and ICD-11 guidelines allow clinicians to assign a co-occurring diagnosis of developmental [motor] coordination disorder (DCD) for autistic individuals with significant motor problems. DCD is characterized by poor motor proficiency with an onset of symptoms in early development. Studies have shown considerable overlap in the behavioral motor features observed in autism and DCD. However, others indicate that motor problems in autism and DCD may stem from different underlying sensorimotor mechanisms. Regardless of whether autism has a unique motor phenotype or an overlap with DCD, changes need to be made in the clinical pipeline to address motor problems in autism at the stages of recognition, assessment, diagnosis, and intervention. Consensus is needed to address unmet needs in research on the etiology of motor problems in autism and their overlap with DCD, to optimize clinical practice guidelines. The development of screening and assessment tools for motor problems that are valid and reliable for use with autistic individuals is essential, and an evidence-based clinical pipeline for motor problems in autism is urgently needed. WHAT THIS PAPER ADDS: Motor problems in autism are highly prevalent, yet underdiagnosed and poorly managed. An evidence-based clinical pipeline for motor problems in autism is urgently needed.

Associations between early language, motor abilities, and later autism traits in infants with typical and elevated likelihood of autism

Slower acquisition of language and motor milestones are common in infants with later autism and studies have indicated that motor skills predict the rate of language development, suggesting these domains of development may be interlinked. However, the inter-relationships between the two domains over development and emerging autistic traits are not fully established. We studied language and motor development using standardized observational and parent-report measures in infants with (n = 271) and without (n = 137) a family history of autism across four waves of data collection from 10 to 36 months. We used Random Intercept Cross-Lagged Panel Models to examine contemporaneous and longitudinal associations between language and motor developments in both elevated and typical likelihood groups. We estimated paths between language and motor abilities at 10, 14, 24, and 36 months and autism trait scores at 36 months, to test whether the domains were interrelated and how they related to emerging autism traits. Results revealed consistent bidirectional Expressive Language (EL) and Fine Motor (FM) cross-lagged effects from 10 to 24 and a unidirectional EL to FM effect from 24 to 36 months as well as significantly correlated random intercepts between Gross motor (GM) and Receptive language (RL), indicating stable concurrent associations over time. However, only the associations between GM and RL were associated with later autism traits. Early motor and language are linked, but only gross motor and receptive language are jointly associated with autistic traits in infants with an autism family history.

Early postnatal development of the MDGA2+/- mouse model of synaptic dysfunction

Synaptic dysfunction underlies many neurodevelopmental disorders (NDDs). The membrane-associated mucin domain-containing glycosylphosphatidylinositol anchor proteins (MDGAs) regulate synaptic development by modulating neurexin-neuroligin complex formation. Since understanding the neurodevelopmental profile and the sex-based differences in the manifestation of the symptoms of NDDs is important for their early diagnosis, we tested a mouse model haploinsufficient for MDGA2 (MDGA2+/-) on a neurodevelopmental test battery, containing sensory, motor, and cognitive measures, as well as ultrasonic vocalizations. When male and female MDGA2+/- and wildtype (WT) C57BL/6 J mice were examined from 2 to 23 days of age using this test battery, genotype and sex differences in body weight, sensory-motor processes, and ultrasonic vocalizations were observed. The auditory startle reflex appeared earlier in the MDGA2+/- than in WT mice and the MDGA2+/- mice produced fewer ultrasonic vocalizations. The MDGA2+/- mice showed reduced locomotion and rearing than WT mice in the open field after 17 days of age and spent less time investigating a novel object than WT mice at 21 days of age. Female MDGA2+/- mice weighed less than WT females and showed lower grip strength, indicating a delay in sensory-motor development in MDGA2+/- mice, which appears to be more pronounced in females than males. The behavioural phenotypes resulting from MDGA2 haploinsufficiency suggests that it shows delayed development of motor behaviour, grip strength and exploratory behaviour, non-social phenotypes of NDDs.

Relationship between quantitative digital behavioral features and clinical profiles in young autistic children

Early behavioral markers for autism include differences in social attention and orienting in response to one's name when called, and differences in body movements and motor abilities. More efficient, scalable, objective, and reliable measures of these behaviors could improve early screening for autism. This study evaluated whether objective and quantitative measures of autism-related behaviors elicited from an app (SenseToKnow) administered on a smartphone or tablet and measured via computer vision analysis (CVA) are correlated with standardized caregiver-report and clinician administered measures of autism-related behaviors and cognitive, language, and motor abilities. This is an essential step in establishing the concurrent validity of a digital phenotyping approach. In a sample of 485 toddlers, 43 of whom were diagnosed with autism, we found that CVA-based gaze variables related to social attention were associated with the level of autism-related behaviors. Two language-related behaviors measured via the app, attention to people during a conversation and responding to one's name being called, were associated with children's language skills. Finally, performance during a bubble popping game was associated with fine motor skills. These findings provide initial support for the concurrent validity of the SenseToKnow app and its potential utility in identifying clinical profiles associated with autism. Future research is needed to determine whether the app can be used as an autism screening tool, can reliably stratify autism-related behaviors, and measure changes in autism-related behaviors over time.

Counting Finger and Wrist Movements Using Only a Wrist-Worn, Inertial Measurement Unit: Toward Practical Wearable Sensing for Hand-Related Healthcare Applications

The ability to count finger and wrist movements throughout the day with a nonobtrusive, wearable sensor could be useful for hand-related healthcare applications, including rehabilitation after a stroke, carpal tunnel syndrome, or hand surgery. Previous approaches have required the user to wear a ring with an embedded magnet or inertial measurement unit (IMU). Here, we demonstrate that it is possible to identify the occurrence of finger and wrist flexion/extension movements based on vibrations detected by a wrist-worn IMU. We developed an approach we call "Hand Activity Recognition through using a Convolutional neural network with Spectrograms" (HARCS) that trains a CNN based on the velocity/acceleration spectrograms that finger/wrist movements create. We validated HARCS with the wrist-worn IMU recordings obtained from twenty stroke survivors during their daily life, where the occurrence of finger/wrist movements was labeled using a previously validated algorithm called HAND using magnetic sensing. The daily number of finger/wrist movements identified by HARCS had a strong positive correlation to the daily number identified by HAND (R² = 0.76, p < 0.001). HARCS was also 75% accurate when we labeled the finger/wrist movements performed by unimpaired participants using optical motion capture. Overall, the ringless sensing of finger/wrist movement occurrence is feasible, although real-world applications may require further accuracy improvements.

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.

Efficacy of Children Neuropsychological and Behavioral Scale in Screening for Autism Spectrum Disorders through a Combination of Developmental Surveillance

OBJECTIVE

This study aimed to explore the clinical value of Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) for Autism Spectrum Disorder (ASD) screening in the presence of developmental surveillance.

METHODS

All participants were evaluated by the CNBS-R2016 and Gesell Developmental Schedules (GDS). Spearman's correlation coefficients and Kappa values were obtained. Taking GDS as a reference assessment, the performance of the CNBS-R2016 for detecting the developmental delays of children with ASD was analyzed with receiver operating characteristic (ROC) curves. The efficacy of the CNBS-R2016 to screen for ASD was explored by comparing Communication Warning Behavior with Autism Diagnostic Observation Schedule, Second Edition (ADOS-2).

RESULTS

In total, 150 children aged 12-42 months with ASD were enrolled. The developmental quotients of the CNBS-R2016 were correlated with those of the GDS (r=0.62-0.94). The CNBS-R2016 and GDS had good diagnostic agreement for developmental delays (Kappa=0.73-0.89), except for Fine Motor. There was a significant difference between the proportions of Fine Motor, delays detected by the CNBS-R2016 and GDS (86.0% vs. 77.3%). With GDS as a standard, the areas under the ROC curves of the CNBS-R2016 were above 0.95 for all the domains except Fine Motor, which was 0.70. In addition, the positive rate of ASD was 100.0% and 93.5% when the cut-off points of 7 and 12 in the Communication Warning Behavior subscale were used, respectively.

CONCLUSION

The CNBS-R2016 performed well in developmental assessment and screening for children with ASD, especially by Communication Warning Behaviors subscale. Therefore, the CNBS-R2016 is worthy of clinical application in children with ASD in China.

Parental Behavior Influences on Motor Skill Development in Young Children with Developmental Disabilities: A Two-Year Longitudinal Study

Young children with developmental disabilities (DDs) experience motor skill deficits compared to their peers without disabilities. Even though parents play an important role in developing their children's motor skills, it has not been widely studied how parental behaviors influence motor skill development in young children with DDs. Therefore, the current study has two main purposes: (a) to examine early motor skill development of preschool aged children (3-5 years) with DDs longitudinally over a two-year period and (b) to longitudinally examine the relationship between parental behaviors and the motor skill development of young children with DDs. Fundamental motor skills (locomotor and object control skills) in 64 young children with DDs and their parent's behavior was measured at five time points when children were between the ages of three and five years. Multilevel modeling was used to examine motor skill progression in young children with DDs and to evaluate the longitudinal relationship between parenting behaviors and motor skill development in young children with DDs. Findings indicated that young children with DDs develop their motor skills in a non-linear fashion across two years. Young children with DDs who have parents with one standard deviation higher (+ SD) in the positive parental behavior than average showed a statistically significant linear increase in the standard scores of locomotor and object-control skills with age (b = 0.27, p = 0.01; b = 0.22, p < 0.01, respectively). This study highlights the importance of positive parenting behaviors in regard to promoting motor skills in young children with DDs.

Parental Perceptions on the Importance of Nutrients for Children with Autism Spectrum Disorder (ASD) and the Coping Strategies: A Qualitative Study

Autism Spectrum Disorder (ASD) is a developmental disorder that comes with co-occurring eating behavior such as limited food varieties, selective food intake, and repetitive eating patterns, contributing to significant challenges for their parents. Many parents find mealtimes difficult and develop anxiety or stress about their child’s nutrition, health, and overall well-being. Hence, parents must equip themselves with the correct awareness and nutrition knowledge. An online open-ended semi-structured interview was conducted among fifteen parents from the community-rehabilitation program center to explore their understanding of nutrition’s importance and the possible coping strategies when facing challenges. The interview sessions were recorded, followed by three researchers’ coding processes. Data were then subjected to thematic analysis. The interview sessions suggested that the parents were aware of the autism trait eating behavior and had a general knowledge about nutrition. However, it was quite challenging when it came to preparation. Nevertheless, the parents are able to manage the challenges with unique kinds of coping strategies. In addition, a complete educational dietary intervention program including psychosocial aspects for parents is recommended for better effectiveness.

Caregiver-Child Agreement in Health-Related Quality of Life of Autistic Children and Adolescents

This study examined the agreement of perceived health-related quality of life (HRQOL) between caregivers and autistic children and adolescents (n = 133, 5-12 years) using the Pediatric Quality of Life Inventory Generic Core Scales, Fourth Edition (PedsQL 4.0). Results reveal good to excellent agreement over this age range across the total, physical, and psychosocial health scales. However, the emotional, social, and school functioning scores demonstrated lower agreement in dyads with children aged 5-7 than in dyads with children aged 8-12 years. Despite these differences in agreement, overall, the PedsQL 4.0 caregiver-module is a reliable instrument for measuring HRQOL in autistic individuals aged 5-12 years.

Cross-replicating findings on unique motor impairments of children with ASD using confirmatory factor analysis and a novel SPARK study sample

A series of recent reports have shed light on the pervasive nature of motor impairments in children with ASD (Bhat, 2020, 2021, Bhat et al., 2022), underscoring the importance of providing ASD clinicians efficient and accurate tools for motor screening. The Developmental Coordination Disorder-Questionnaire (DCD-Q) is a widely used motor screening tool, yet scant evidence exists regarding its psychometric properties in children with ASD. In a recent Exploratory Factor Analysis (EFA) of the 15-item DCD-Q in a large sample of children with ASD (SPARK study), we found a 5-factor latent structure that identified unique motor impairments in a large sample of children with ASD (Bhat et al., 2022). In the current study, we extend this work by cross-replicating the EFA findings of unique ASD-related motor issues using Confirmatory Factor Analysis (CFA) in a new, more recent wave of children with ASD from the SPARK study (N = 9721). The fits and interpretability of 11 hypothesis-driven CFA models, including 8 correlated-factors, 1 second-order, and 2 bifactor models were compared. Our findings supported the previous 5-factor model with 2 gross motor subdomains, 1 fine motor domain (similar to the original DCD-Q) and 2 general coordination subdomains. This model demonstrated acceptable fit in the new sample as well as superior fit compared to several other parsimonious correlated-factors models. However, the second-order and bifactor models fit slightly better and supported the presence of a general motor skills factor, although 38% of the common variance in the DCD-Q items remained attributable to the 5 subdomains. Using one of the bifactor models, measurement invariance was also supported for DCD-Q across sex, race, and co-occurring conditions of language disorder and intellectual disability. Only partial invariance was supported when testing DCD-Q scores across different age groups. These findings reveal a more complex dimensional picture of the DCD-Q in children with ASD. Results suggest that the DCD-Q can be used in two ways, total scores adequately assess general motor skills for brief screening and subdomain scores offer unique information on the multidimensional motor problems of children with ASD. If subdomain data are of interest, our findings call into question the practice of relying on 3 original subscales of the DCD-Q when screening for ASD-related motor difficulties, whereas 4 out of 5 subscale scores may better highlight domain-specific motor problems. Future studies should continue to further validate DCD-Q's ability to screen for multidimensional motor problems.

Group versus individual occupational therapy for toddlers with autism as a means to improve access to public health-care services. Randomised controlled pilot study

INTRODUCTION

In recent years, the increasing prevalence of autism-spectrum disorder has resulted in an increased demand for therapies including occupational therapy. In this pilot trial, we aimed to compare the efficacy of group versus individual occupational therapy among toddlers with autism as a means to improve accessibility to care.

METHODS

Toddlers (2-4 years) undergoing autism evaluation in our public child developmental centre were recruited and randomised to receive 12 weekly sessions of group or individual occupational therapy based on the same mode of intervention: Developmental, Individual-Differences and Relationship-based (DIR). Primary outcomes related to intervention implementation included waiting days, nonattendance, intervention period, number of sessions attended and therapist satisfaction. Secondary outcomes were the Adaptive Behaviour Assessment System questionnaire, the Paediatric Quality of Life Inventory and the Peabody Developmental Motor Scale (PDMS-2).

RESULTS

Twenty toddlers with autism were included, 10 in each occupational therapy mode of intervention. Children waited fewer days before beginning group occupational therapy compared to individual therapy (52.4 ± 28.1 vs. 108.8 ± 48.0 days p < 0.01). Mean numbers of nonattendance was similar for both interventions (3.2 ± 2.82 vs. 2 ± 1.76, p > 0.05). Worker satisfaction scores were similar at the beginning and end of the study (6.1 ± 0.4 vs. 6.07 ± 0.49, p > 0.05). There were no significant differences between the percentage changes in individual and group therapy outcomes for adaptive score (6.0 ± 16.0 vs. 4.5 ± 17.9, p > 0.05), quality of life (1.3 ± 20.9 vs. 18.8 ± 24.5, p > 0.05) and fine motor skills (13.7 ± 36.1 vs. 15.1 ± 41.5, p > 0.05).

CONCLUSIONS

In this pilot study, the group DIR-based occupational therapy for toddlers with autism improved access to services and allowed earlier interventions, with no clinical inferiority to individual therapy. Further research is required to examine group clinical therapy benefit.

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.

Developmental Functioning of Infants and Toddlers with Neurodevelopmental Disorders

PURPOSE

The current study aimed to investigate developmental functioning in infants and toddlers with autism spectrum disorder (ASD), seizures, cerebral palsy (CP), and atypical development.

METHODS

An ANOVA was utilized to investigate the differences between neurodevelopmental group on BDI-2 developmental quotient and a MANOVA was used to investigate the differences between the groups and five developmental domains.

RESULTS

The results indicated statistically significant differences in overall developmental functioning and each subdomain of the BDI-2.

DISCUSSION

These findings provide the basis for further research to investigate comorbidities of the three neurodevelopmental disorders and parse out the impact of intellectual disability (ID).

The Pull-to-Sit Task: Examining Infant Postural Development in Autism Spectrum Disorder

OBJECTIVE

To evaluate the predictive relationship between early trajectories of postural and head control during a pull-to-sit task and later autism diagnostic and developmental outcomes.

STUDY DESIGN

Using a prospective longitudinal design, postural skills of 100 infants at elevated and low familial likelihood of autism spectrum disorder (ASD) were evaluated using a pull-to-sit task monthly from age 1 month to 6 months. At age 24 months, infants were seen for a developmental and diagnostic evaluation completed by examiners masked to participant group. Latent growth curve models were used to compare early trajectories of pull-to-sit performance in infants later diagnosed with ASD and typically developing infants and to predict developmental outcomes.

RESULTS

Pull-to-sit trajectories did not differ in infants with an elevated likelihood of ASD or infants with ASD compared with low-likelihood and typically developing infants, but infants with ASD were more likely to exhibit a head lag by age 4 months. In addition, pull-to-sit trajectories were predictive of social and speech skills 2 years later.

CONCLUSIONS

These findings highlight the link between very early pull-to-sit skills and later social and language outcomes. Atypical postural development and persistent presence of head lag may be important early indicators of social and language vulnerabilities, including ASD.

Promoting Positive Health Outcomes in an Urban Community-Based Physical Activity Intervention for Preschool Aged Children on the Autism Spectrum

While there is wide consensus regarding the importance of early intervention, health is rarely considered within priorities. Twenty-five children on the autism spectrum (M_age = 4.67, SD = 0.82) participated in a 12-week physical activity intervention. Primary objective was to examine impact of a physical activity intervention on physical activity, fitness and motor competence. Secondary objective was to examine associations between motor behavior and ASD symptoms. Ball skills (p < .001) and isometric push-up performance (p = .02) improved. Autism symptoms were associated with motor skills (r > -  .49, p < .05). Study outcomes provide new knowledge regarding design, delivery, and measures for early interventions targeting health disparities in young children on the autism spectrum.

Multidimensional motor performance in children with autism mostly remains stable with age and predicts social communication delay, language delay, functional delay, and repetitive behavior severity after accounting for intellectual disability or cognitive delay: A SPARK dataset analysis

When motor difficulties continue into adolescence/adulthood, they could negatively impact an individual with autism spectrum disorder (ASD)'s daily living skills, physical fitness, as well as physical and mental health/well-being. Few studies have examined motor difficulties in children with ASD as a function of sex or age; however, greater cognitive challenges are associated with worse general motor performance. Based on the Developmental Coordination Disorder-Questionnaire (DCD-Q) data from the SPARK study sample, 87%-88% children with ASD were at-risk for a general motor impairment that persisted until 15 years and was related to their core and co-occurring difficulties. Bhat et al. confirmed motor difficulties in children with ASD on multiple motor dimensions that predicted core and co-occurring conditions after accounting for age and sex. However, presence of intellectual disability (ID) or cognitive delay was not controlled in the previous analysis. Additionally, the effects of age, sex, and cognitive ability on multidimensional motor difficulties of the SPARK sample have not been discussed before. Therefore, this analysis examines the effects of age, sex, and cognitive ability (presence of ID or level of cognitive delay) on the motor performance of children from the SPARK sample using the DCD-Q. Except fine motor skills, multiple motor domains did not change with age in children with ASD. Females without ID improved their fine motor scores with age, and performed better compared to males without ID. Children with ASD and ID had greater motor difficulties across multiple motor domains than those without ID. Even after controlling for age, sex, and presence of ID/cognitive delay; motor performance was predictive of social communication skills, repetitive behavior severity, as well as language and functional delays. Gross motor skills contributed more than fine motor and general motor competence skills in predicting social communication delay. However, fine motor and general motor competence skills contributed more than gross motor skills in predicting repetitive behavior severity and language delay. Both, fine and gross motor skills predicted functional delay. In light of consistent findings on motor difficulties in children with ASD, adding motor issues as a specifier within the ASD definition could provide a clear clinical route for movement clinicians to address motor difficulties of individuals with ASD.

Developmental Functioning of Toddlers At-Risk for Autism With and Without Down Syndrome

PURPOSE

Due to the difficulties in differentiating between impairments associated with intellectual disability and ASD symptomology, DS often leads to delayed or misdiagnoses of ASD.

METHOD

An ANOVA was run to investigate the effects of ASD risk and DS on overall developmental functioning across three groups: ASD+, DS-, and DS+ (n = 138). A MANOVA was run to investigate the differences of group on five developmental subdomains.

RESULTS

The results revealed significant group differences in the overall developmental functioning and each developmental subdomain. Children in the DS+ group demonstrated significantly lower overall developmental functioning, as well as lower adaptive, cognitive, motor, and communication skills compared to their peers; however, children in the DS- group demonstrated significantly better social skills compared to their peers in the ASD+ group.

DISCUSSION

These findings support the need for early screening and identification of ASD among those with DS.

Early Developmental Trends in High-Risk Neonates Later Diagnosed With Autism Spectrum Disorder

PURPOSE

We hypothesized that clinical data from a neonatal intensive care unit (NICU) infant developmental follow-up clinic would identify early manifestations of autism spectrum disorder (ASD).

METHODS

One hundred forty-four infants were identified; 72 later diagnosed with ASD and 72 controls. Retrospective chart review provided data from the Test of Infant Motor Performance (TIMP) and the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), between 8 and 26 months of age.

RESULTS

Between-group comparisons indicated no significant group difference in TIMP scores; however, Bayley-III scaled scores differed between the groups at 2 administration times. The within-group Bayley-III change scores declined significantly more for the ASD group in cognitive and communication subtests.

CONCLUSION

High-risk neonates, due to prematurity or morbidity, later diagnosed with ASD demonstrated statistically significant differences, including a more precipitous drop in Bayley-III scores over time. Early, longitudinal developmental surveillance for neonates at risk of ASD is critical. What this adds to the evidence: Early identification of ASD is critical to optimize developmental outcomes in young children, including infants born prematurely or with neonatal morbidity, who are perceived to have an increased risk for ASD. Despite these findings, minimal research has been conducted to evaluate the utility of commonly administered norm-referenced developmental surveillance instruments to identify possible early signs of ASD in this high-risk population due to prematurity or neonatal morbidity and not familial association. The present study analyzed retrospectively collected clinical data from a NICU developmental follow-up clinic for 144 infants, 72 of which were later diagnosed with ASD and 72 sex- and gestational age-matched controls. Results demonstrated statistically significant poorer Bayley-III outcomes for the ASD group compared with controls at 2 different study time points, including a more precipitous drop in Bayley-III scaled scores over time. This study highlights the importance of early and longitudinal developmental surveillance for high-risk neonates at risk of ASD.

Bidding on the go: Links between walking, social actions, and caregiver responses in infant siblings of children with autism spectrum disorder

The development of walking is associated with a shift in how neurotypical infants initiate social interactions. Walking infants are more likely to locate objects in distant places, carry them, and then share those objects by approaching caregivers and using gestures to show or offer their discoveries (i.e., moving bids). The simultaneous organization of the behaviors necessary to generate moving bids requires the coordination of multiple skills-walking, fine motor skills, and gesturing. Infants with an elevated likelihood (EL) for autism spectrum disorder (ASD) exhibit differences and delays in each of these behaviors. This study investigated interconnections between infant walking, social actions, and caregiver responses in 18-month-old EL infants with diverse developmental outcomes (ASD, non-ASD language delay, no diagnosis). We observed 85 infant-caregiver dyads at home during everyday activities for 45 minutes and identified all times when infants walked, instances of walking paired with social action (i.e., approaching the caregiver, approaching while carrying an object, producing a moving bid), and whether caregivers responded to their infants' social actions. There were no group differences in infants' production of social actions. Caregiver responses, however, were more clearly modulated by outcome group. While all caregivers were similarly and highly likely to respond to moving bids, caregivers of EL-ASD infants were substantially more likely to respond when their infants simply approached them (with or without an object in hand). Taken together, this research underscores the complexity of EL infant-caregiver interactions and highlights the role that each partner plays in shaping how they unfold.

Comparing the Movement Assessment Battery for Children with the Bruininks‐Oseretsky Test of Motor Proficiency in adolescents with and without schizophrenia

BACKGROUND

As motor impairments have implications for health and functioning, they need to be addressed early, not only in childhood but also in adolescence, the period in which mental disorders as schizophrenia, typically develops. Further, the possible prognostic value of motor impairments in schizophrenia highlights the importance. The Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) and the Movement Assessment Battery for Children (MABC-2) assess adolescent motor performance. However, MABC-2 is not valid past age 16 and has no sex-norms. Further, while the concurrent validity between the tests and their ability to distinguish between clinical and non-clinical groups has been established in children, however they have not been established in adolescence.

PURPOSE

To compare the ability of MABC-2 and BOT-2 to distinguish between adolescents with and without schizophrenia, to examine the concurrent validity between tests, to examine the agreement between tests in classifying adolescents "at risk" or scoring "below average" and to examine the influence of age and sex on MABC-2.

METHOD

Motor performance assessed by BOT-2 and MABC-2 was compared in 25 adolescents with schizophrenia (14-18) and age- and sex-matched controls using t-test, Cohen's D and false discovery rate's q-value. The associations between tests were assessed using Pearson's correlation and Lin's concordance correlation coefficient. The Kappa coefficient was used to assess the agreement between tests in classifying "risk/below average" and linear regression was adopted to assess the influence of age/sex on MABC-2.

RESULTS

MABC-2 and BOT-2 significantly distinguished adolescents with schizophrenia from controls with large effect size. A strong association (p > 0.001) was found between the tests. The tests revealed moderate agreement in identifying "risk" or scoring "below average". Only sex influenced MABC-2 scores.

CONCLUSION

MABC-2 and BOT-2 are both useful for assessing motor performance and distinguishing between adolescents with and without schizophrenia, although BOT-2 provides a more detailed picture of the challenges in adolescent with schizophrenia.

Family life and autistic children with sensory processing differences: A qualitative evidence synthesis of occupational participation

Autistic children with sensory processing differences successfully navigate and engage in meaningful family daily occupations within home and community environments through the support of their family. To date however, much of the research on autistic children with sensory processing differences, has primarily been deficit focused, while much of the caregiver research has focused on issues of distress, burden, effort, and emotional trauma in coping with their child's diagnosis. This study aimed to conduct a qualitative evidence synthesis, using a meta-ethnographic approach to explore the gap identified in understanding successful occupational experiences of family participation and daily family routines when supporting an autistic child with sensory processing differences and to offer an alternative strengths-based perspective. Inclusion criteria were studies which were peer-reviewed qualitative design, published from 2000 to 2021, and that concerned parents/caregivers' perspectives of family occupations of children diagnosed with autism spectrum disorder. Studies were electronically searched in eight databases from October to December 2021 and 23 studies were identified which met the inclusion criteria. Noblit and Hare's seven step approach for conducting analysis in meta-ethnography was used, and three themes identified: (1) sensory processing differences in daily life, (2) what is hard about hard, and (3) orchestrating family life. Results identified the centrality of sensory experiences in understanding family life. Living with unpredictability while orchestrating certainty through routines was core to successful participation. This review provides insights into how parents negotiate the complexities of constructing family life when living with an autistic child. The results can inform the design of future interventions that specifically address the relationship between meaningful participation in family occupations and daily routines and sensory processing in autistic children.

Development of an ICT-Based Exergame Program for Children with Developmental Disabilities

The purpose of this study was to develop an information and communications technology (ICT)-based exergame for children with developmental disabilities (DD) and to examine its impacts on physical fitness and fundamental motor skills (FMS). The ICT-based exergame consisted of visual and auditory demonstrations of diverse locomotor movement and object manipulation activities by the virtual characters. A total of 52 children with DD participated in the present study. The participants were divided into twenty-seven children in the experimental group and 25 children with DD in the control group. The experimental group participants engaged in the exergame program for 12 weeks. All participants’ muscle strength (i.e., standing long jump) and four fundamental motor skills, such as the horizontal jump, hop, overhand throw, and dribble, were assessed during the pre- and post-test process. There were significant impacts on physical fitness and FMS (p < 0.001) between the groups. Specifically, the results of three FMS (hop, overhand throw, and dribble) and standing long jump significantly improved in children with DD except for the horizontal jump skill. The results of this study is evidence that the ICT-based exergame program for children with DD may be utilized to improve physical fitness and FMS in children with DD.

Mediating effect of sequential memory on the relationship between visual-motor integration and self-care performance in young children with autism spectrum disorder

Objective

Visual perception is a skill that contributes to the performance of self-care and important development tasks in early childhood. The relationship between self-care and visual perception is especially significant for young children with autism spectrum disorder (ASD), who have been described as visual learners. However, this relationship is not clearly understood among young children with ASD. We investigated the role of motor-free visual perception on the relationship between self-care and visual-motor integration in young children with ASD.

Methods

A sample of 66 children with ASD aged 48 to 83 months were recruited. Measurements included the Assessment of Motor and Process Skills, the Developmental Test of Visual Perception—Third Edition, and Test of Visual-Perceptual Skills—Third Edition.

Results

The results indicated that self-care performance had significant positive correlations with visual-motor integration, visual discrimination, visual memory, visual spatial relationships, and visual sequential memory. Of these, visual sequential memory and visual spatial relationships were the main factors related to self-care performance. Sequential memory was a mediator of the relationship between visual-motor integration and self-care performance.

Conclusion

This study establishes a deeper understanding of self-care and motor-free visual perception among young children with ASD. Understanding the relationship between visual perception and self-care in young children with ASD may aid professionals in providing self-care interventions for this population.

Combined Gait and Grasping in Autistic and Non-Autistic Youths

This study was designed to extend research on motor skill development in autism spectrum disorder using a dual-task skill. Nine autistic and 18 non-autistic youths walked without grasping or while reaching to grasp a small or large object. Step extremity ratio, percent time in double support, and normalized speed were quantified. We hypothesized that gait would differ between autistic and non-autistic youth and that differences would be moderated by the phase (approach and grasp) and the complexity of the task (walking and grasping versus walking alone). Although gait parameters were similar during the walking-only trials, the combined task resulted in slower speed and shorter steps in autistic youth, particularly during the grasp phase. These findings, while in a small sample, offer preliminary evidence that autistic youth who show typical gait during simple assessments of motor ability may have difficulties in more complex tasks that require the coordination of movements.

Instructors' Perspectives of Social and Motor Influences on Participation in Children With Autism Spectrum Disorder

Participation is key to childhood development and is essential for health and well-being; yet children with Autism Spectrum Disorder (ASD) participate less in social and physical activities compared to their typically developing peers and little is known about how social and motor challenges impact participation patterns. Purpose: The current research garnered experiential insights of the quality and quantity of participation, through the lens of instructors (N = 9) working with a child or children with ASD. Method: Semi-structured qualitative interviews were conducted to capture a comprehensive and informative profile of how social and motor functioning of children with ASD influence involvement in social and physical activities. Results: Thematic analysis revealed consistent viewpoints in four main areas: (1) Viewpoints extend beyond the World Health Organization definition of participation; (2) Participation depends on who is involved; (3) Although motivation, confidence, and competence in social/motor domains underlie participation, social challenges were perceived as the greatest barrier; (4) While acknowledging the benefits of participation, it is necessary to be cognizant of the required supports. Throughout these themes, the notion of heterogeneity was made very clear. Conclusion: Collectively, perspectives offer descriptive insight which may be useful when designing opportunities for participation in social and physical activities among children with ASD.

Reduced asymmetry of the hand knob area and decreased sensorimotor u-fiber connectivity in middle-aged adults with autism

Individuals with autism spectrum disorder (ASD) frequently present with impairments in motor skills (e.g., limb coordination, handwriting and balance), which are observed across the lifespan but remain largely untreated. Many adults with ASD may thus experience adverse motor outcomes in aging, when physical decline naturally occurs. The 'hand knob' of the sensorimotor cortex is an area that is critical for motor control of the fingers and hands. However, this region has received little attention in ASD research, especially in adults after midlife. The hand knob area of the precentral (PrC_hand) and postcentral (PoC_hand) gyri was semi-manually delineated in 49 right-handed adults (25 ASD, 24 typical comparison [TC] participants, aged 41-70 years). Using multimodal (T1-weighted, diffusion-weighted, and resting-state functional) MRI, we examined the morphology, ipsilateral connectivity and laterality of these regions. We also explored correlations between hand knob measures with motor skills and autism symptoms, and between structural and functional connectivity measures. Bayesian analyses indicated moderate evidence of group effects with greater right PrC_hand volume and reduced leftward laterality of PrC_hand and PoC_hand volume in the ASD relative to TC group. Furthermore, the right PoC-PrC_hand u-fibers showed increased mean diffusivity in the ASD group. In the ASD group, right u-fiber volume positively correlated with corresponding functional connectivity but did not survive multiple comparisons correction. Correlations of hand knob measures and behavior were observed in the ASD group but did not survive multiple comparisons correction. Our findings suggest that morphological laterality and u-fiber connectivity of the sensorimotor network, putatively involved in hand motor/premotor function, may be diminished in middle-aged adults with ASD, perhaps rendering them more vulnerable to motor decline in old age. The altered morphology may relate to atypical functional motor asymmetries found in ASD earlier in life, possibly reflecting altered functional asymmetries over time.

Occupational Therapy Using Ayres Sensory Integration®: A Randomized Controlled Trial in Brazil

IMPORTANCE

Research conducted in the United States has found that occupational therapy using Ayres Sensory Integration® is an effective evidence-based intervention for children with autism spectrum disorder (ASD). Replication of this research in other cultures is needed.

OBJECTIVE

To evaluate the outcomes of occupational therapy using Ayres Sensory Integration in a sample of Brazilian children with ASD.

DESIGN

Prospective randomized controlled trial.

SETTING

Occupational therapy clinic.

PARTICIPANTS

Seventeen children with ASD ages 5-8 yr (n = 9 in the intervention group, n = 8 in the usual-care control group) recruited from a local hospital via flyers and word-of-mouth. Completed pretreatment characterization and baseline measurement.

INTERVENTIONS

The intervention group received occupational therapy using Ayres Sensory Integration, and the control group received usual therapeutic and educational services only.

OUTCOMES AND MEASURES

We conducted a pre-post assessment of self-care and socialization using the Pediatric Evaluation of Disability Inventory and individualized goal ratings.

RESULTS

Participants in the intervention group scored significantly higher on outcome measures of self-care (p = .046, rb = .57), social function (p = .036, rb = .61), and parent-identified goal attainment (p < .001, rb = .94) compared with the control group.

CONCLUSIONS AND RELEVANCE

Occupational therapy using Ayres Sensory Integration was effective in enhancing self-care, socialization, and goal attainment for children with ASD in a Brazilian cohort. What This Article Adds: This study contributes further support from outside the United States that occupational therapy using Ayres Sensory Integration is an effective evidence-based intervention to improve self-care, socialization, and parent-identified goal attainment in children with ASD.

Little Evidence for Conservative Toe Walking Interventions in Autism Spectrum Disorders: a Systematic Review

This systematic review summarizes the evidence about toe walking (TW) interventions in persons with autism. Following the PRISMA guidelines, a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane Library, Google Scholar, and Opengrey was performed. Nine articles (all case reports or case series) were included. Methodological quality was assessed using the Mayo Evidence-Based Practice Centre tool. The included studies considered 17 subjects (16 males; age range: 4–15 years). All studies reported a reduction of TW frequency, but the follow-up was lacking in seven studies. There is a lack of high-quality studies with a sufficiently large and well-characterized sample to assess the effectiveness of TW interventions in autistic persons. These findings strongly support the need for further research in this area.

Clinical autism subscales have common genetic liabilities that are heritable, pleiotropic, and generalizable to the general population

The complexity of autism's phenotypic spectra is well-known, yet most genetic research uses case-control status as the target trait. It is undetermined if autistic symptom domain severity underlying this heterogeneity is heritable and pleiotropic with other psychiatric and behavior traits in the same manner as autism case-control status. In N = 6064 autistic children in the SPARK cohort, we investigated the common genetic properties of twelve subscales from three clinical autism instruments measuring autistic traits: the Social Communication Questionnaire (SCQ), the Repetitive Behavior Scale-Revised (RBS-R), and the Developmental Coordination Disorder Questionnaire (DCDQ). Educational attainment polygenic scores (PGS) were significantly negatively correlated with eleven subscales, while ADHD and major depression PGS were positively correlated with ten and eight of the autism subscales, respectively. Loneliness and neuroticism PGS were also positively correlated with many subscales. Significant PGS by sex interactions were found-surprisingly, the autism case-control PGS was negatively correlated in females and had no strong correlation in males. SNP-heritability of the DCDQ subscales ranged from 0.04 to 0.08, RBS-R subscales ranged from 0.09 to 0.24, and SCQ subscales ranged from 0 to 0.12. GWAS in SPARK followed by estimation of polygenic scores (PGS) in the typically-developing ABCD cohort (N = 5285), revealed significant associations of RBS-R subscale PGS with autism-related behavioral traits, with several subscale PGS more strongly correlated than the autism case-control PGS. Overall, our analyses suggest that the clinical autism subscale traits show variability in SNP-heritability, PGS associations, and significant PGS by sex interactions, underscoring the heterogeneity in autistic traits at a genetic level. Furthermore, of the three instruments investigated, the RBS-R shows the greatest evidence of genetic signal in both (1) autistic samples (greater heritability) and (2) general population samples (strongest PGS associations).

The Impact of a Rater Training Program on the TGMD-3 Scoring Accuracy of Pre-Service Adapted Physical Education Teachers

This study aimed to examine the impact of a TGMD-3 rater training program on pre-service adapted physical education (APE) teachers’ ability to score fundamental motor skills for children with developmental disabilities (DD). The training program consisted of a description of the TGMD-3 instrument and DD, as well as content focused on skill performance and correct scoring through systematic analysis of 13 FMS via the instrument. Three experts established the standard score through the TGMD-3 performance evaluation of a child with DD. Thirty-nine pre-service APE teachers in the experimental group and 30 pre-service teachers in the control group completed the pre- and post-test process in this study. There were significant impacts on the pre-service teachers’ ability to score the locomotor, ball skill subtests, and total skill scores (p < 0.05) compared to the control group. Specifically, the results of the three locomotor skills (running, horizontal jump, & slide) and three ball skills (two-hand strike, dribble, & kick) significantly improved in scoring accuracy. The results of this study can evidence that a TGMD-3 rater training program for pre-service APE teachers enhances the scoring accuracy of FMS among children with DD.

The effect of learning to drum on behavior and brain function in autistic adolescents

This current study aimed to investigate the impact of drum training on behavior and brain function in autistic adolescents with no prior drumming experience. Thirty-six autistic adolescents were recruited and randomly assigned to one of two groups. The drum group received individual drum tuition (two lessons per week over an 8-wk period), while the control group did not. All participants attended a testing session before and after the 8-wk period. Each session included a drumming assessment, an MRI scan, and a parent completing questionnaires relating to the participants’ behavioral difficulties. Results showed that improvements in drumming performance were associated with a significant reduction in hyperactivity and inattention difficulties in drummers compared to controls. The fMRI results demonstrated increased functional connectivity in brain areas responsible for inhibitory control, action outcomes monitoring, and self-regulation. In particular, seed-to-voxel analyses revealed an increased functional connectivity in the right inferior frontal gyrus and the right dorsolateral prefrontal cortex. A multivariate pattern analysis demonstrated significant changes in the medial frontal cortex, the left and right paracingulate cortex, the subcallosal cortex, the left frontal pole, the caudate, and the left nucleus accumbens. In conclusion, this study investigates the impact of a drum-based intervention on neural and behavioral outcomes in autistic adolescents. We hope that these findings will inform further research and trials into the potential use of drum-based interventions in benefitting clinical populations with inhibition-related disorders and emotional and behavioral difficulties.

Autistic Children Use Less Efficient Goal-Directed Whole Body Movements Compared to Neurotypical Development

Autistic children have differences in their movements which impact their functional performance. Virtual-reality enables researchers to study movement in safe, engaging environments. We used motion-capture to measure how 7-13-year-old autistic and neurotypical children make whole-body movements in a virtual-reality task. Although children in both groups were successful, we observed differences in their movements. Autistic children were less efficient moving to the target. Autistic children did not appear to use a movement strategy. While neurotypical children were more likely to overshoot near targets and undershoot far targets, autistic children did not modulate their strategy. Using kinematic data from tasks in virtual-reality, we can begin to understand the pattern of movement challenges experienced by autistic children.