Association between Social Skills and Motor Skills in Individuals with Autism Spectrum Disorder: A Systematic Review

Atypical implicit and explicit sense of agency in autism: A complete characterization using the cue integration approach

There exist indications that sense of agency (SoA), the experience of being the cause of one's own actions and actions' outcomes, is altered in autism. However, no studies in autism have simultaneously investigated the integration mechanisms underpinning both implicit and explicit SoA, the two levels of agency proposed by the innovative cue integration approach. Our study establishes a first complete characterization of SoA functioning in autism, by comparing age- and IQ-matched samples of autistic versus neurotypical adults. Intentional binding and judgments of agency were used to assess implicit and explicit SoA over pinching movements with visual outcomes. Sensorimotor and contextual cues were manipulated using feedback alteration and induced belief about the cause of actions' outcome. Implicit SoA was altered in autism, as showed by an overall abolished intentional binding effect and greater inter-individual heterogeneity. At the explicit level, we observed under-reliance on retrospective sensorimotor cues. The implicit-explicit dynamic was also altered in comparison to neurotypical individuals. Our results show that both implicit and explicit levels of SoA, as well as the dynamic between the two levels, present atypicalities in autism.

A scoping review of the motor impairments in autism spectrum disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder mainly defined by impairments in communication and socialization. Although motor symptoms are not typically considered central to the disease, their high frequency and early onset have been recurrently reported in the literature. Therefore, this scoping review provides a broad description of these motor impairments across all ages, as well as a discussion of their relevance and relation to other clinical aspects of ASD. The scientific search was carried out in Scopus, Pubmed, Embase, and Web of Science databases. Nineteen studies were selected after applying the eligibility criteria. The studies analyzed 784 participants diagnosed with ASD compared to 540 controls. Motor function was assessed by means of varied kinds of scales and questionnaires. The main motor domains evaluated included features of fine and gross motor skills, manual dexterity, coordination/motor control/praxis, balance, running speed/agility, strength, gait, whole-body movements, aiming and catching (ball skills), and repetitive movements. Motor impairments are consistently observed in ASD from the first years of life, persisting into adulthood. It includes a significant deficit in performance of manual, posture, strength, and gait behavior/skills. The deficits described in ASD comprised impairments in fine and gross motor skills, lower balance, lower cadence, and greater variation of gait control, as well as weakness among other features that leads this population to move in an adaptive way affecting their interactions in real life.

Relationship between play skills and sensory processing in children with autism

Play skills in children with autism are limited due to autism symptoms. It is important to determine the effect of sensory processing skill, which is one of these symptoms, on play skills. Therefore, we aimed to investigate of the relationship between play skills and sensory processing of children with autism. A total of 58 children with autism (n = 29) and typically developing children (n = 29) participated. We used the Sensory Profile and the Revised Knox Preschool Play Scale. Spearman's correlation coefficient was used. Children with autism demonstrated a significantly lower developmental play age and were rated lower on all dimensions of the RKPPS than typically developing children. Moreover, the results of this study showed that there are complex correlations between play skills and sensory processing in children with autism. Sensory processing and play skills have complex relationships in children with autism.

Effects of Creative Movement, General Movement, or Seated Play Interventions on Motor Performance in Children with Autism Spectrum Disorder: A Pilot Randomized Controlled Trial

Background

Children with ASD experience significant gross motor challenges that could be addressed using motor interventions. However, contemporary ASD interventions that are sedentary in nature often target communication and fine motor skills and not children's gross motor difficulties.

Methods

In the current pilot RCT, we evaluated changes in various motor outcomes (i.e., gross/fine motor coordination, locomotor skills, functional endurance, and praxis/imitation performance) following two types of whole-body motor interventions (Creative Movement (CM) or General Movement (GM)) and compared them to a Sedentary Play (SP) intervention focused on improving fine motor skills in children with ASD. Forty-five children with ASD (Mean Age ±SE: 8.7 ± 0.3, 38 males) were randomly assigned to the CM, GM, or SP groups and received 8 weeks of group-specific training.

Results

Both CM and GM interventions led to medium-to-large improvements in gross motor performance, including improved body coordination, strength/agility, locomotor skills, and walking endurance. Children in the CM group additionally showed medium-to-large-sized improvements in praxis performance, while children in the SP group showed improvements in fine motor performance. These training-related improvements were supported by improvements reported via parental questionnaires.

Conclusions

Researchers and clinicians should incorporate whole-body interventions targeting gross motor skills in the plan of care for children with ASD.

Motor Competence in Autistic Children with Attention-Deficit Hyperactivity Disorder

BACKGROUND/OBJECTIVES

Children with autism exhibit deficits in fundamental motor skills, which are intensified when associated with attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE

To correlate motor competence in children with autism, autism levels according to the CARS scale, and the association with ADHD.

METHODS

This cross-sectional study assessed motor competence using the Motor Competence Assessment (MCA), the severity of Autism Spectrum Disorder by Childhood Autism Rating Scale (CARS), and the presence of clinical signs for ADHD using Swanson, Nolan, and Pelham (SNAP-IV) questionnaire. A total of 68 children were recruited; however, 23 were not included due to non-acceptance and/or were excluded because of associated pathologies, high autism severity. Consequently, 45 children (11 with ADHD) between the ages of 5 and 11 (Mean: 8.15; ±1.75) with 83.72% being male.

RESULTS

Multiple linear regression revealed a significant inverse correlation between MCA scores and raw CARS data (p = 0.01), indicating that greater autism severity is associated with lower motor competence. The correlation was also observed in CARS classifications, with higher autism severity corresponding to lower motor percentiles (p = 0.05). However, the correlation between the presence of ADHD and motor competence in children with ASD did not reach significance. Overall, a significant correlation was observed (p = 0.006) when analyzing all variables (CARS scores, SNAP scores, and CARS classification).

CONCLUSION

Therefore, it is believed that children with autism exhibit deficits in functional motor skills, with severity impacting motor competence. The findings underscore the need for systematic motor skill assessments in children with autism, emphasizing the importance of monitoring and intervention in this aspect of their development.

Equine-assisted services for motor outcomes of autistic children: A systematic review

LAY ABSTRACT

Equine-assisted services use various aspects of horses, like their movement, warmth, and size, to enhance individuals' overall well-being. Many studies have underscored the positive impact of equine-assisted services on autistic children, affecting areas such as social interaction, communication, engagement, stereotypical behaviors, and motor functions. Given the growing recognition of motor functions as clinical specifiers in autism, it is imperative to specifically investigate how equine-assisted services influence these outcomes. To address this, we conducted a systematic review to synthesize existing literature on the effects of equine-assisted services on motor outcomes of autistic children. Our review encompassed study characteristics, features of equine-assisted service interventions, and major motor outcomes. We also evaluated the methodological quality of the equine-assisted service studies to offer insights for future research directions. Through thorough database searches and the use of the standardized procedure of conducting a systematic review (The Preferred Reporting Items for Systematic Reviews and Meta-analyses), 12 research studies were identified and included. These studies reported the effects of various equine-assisted service types (such as therapy, horsemanship, or learning) on motor outcomes of autistic children. Significant enhancements in coordination, strength, balance, posture, and overall motor skills indicate the effectiveness of equine-assisted services in improving motor outcomes of autistic children. Building on these findings, we provide recommendations for future research endeavors aimed at enhancing the reliability and validity of using equine-assisted services to improve motor outcomes of autistic children. This work contributes to a deeper understanding of how equine-assisted services can benefit this population and guides the development of more effective equine-assisted service interventions.

A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum Disorder

Introduction: Children with upper extremity neuromotor impairments often have decreased participation in life activities. Hippotherapy and rehabilitation in the equine environment might be effective in targeting participation, given the community context and natural activity involvement. This randomized controlled feasibility trial assessed recruitment, retention, treatment fidelity, and acceptability of rehabilitation using hippotherapy and the equine environment, targeting upper extremity function and participation for children with neuromotor impairments to inform a larger trial. Methods: This 6-month trial occurred in Ohio, June-December 2021. Participants were 6-17 years old with upper extremity neuromotor impairment (and primary diagnosis of cerebral palsy and/or autism). Participants were randomized into treatment or waitlist control using REDCap. Treatment was 16 h (4 h/week/4 weeks) of rehabilitation using hippotherapy and the equine environment. Control participants completed a 4-week waiting period, then received the treatment. Recruitment, screening, enrollment, attendance, and retention were tracked. Nonblinded assessments of body structures and functions, activity, and participation were administered pre- and postcontrol and treatment. Assessment measure completion, treatment fidelity, and acceptability were recorded. Results: Twenty-six participants were screened between July and October 2021; 77% (20/26) met inclusion criteria; 70% (14/20) enrolled and randomized: 6 control and 8 treatment. Two withdrew after randomization and one was excluded for fear of horses. In total, n = 5 control and n = 6 treatment completed initial assessment. Retention was 80% (4/5) control and 83% (5/6) treatment, just below the a priori criteria (85%). Assessment measure completion was variable (77%-100%) and replacement of some should be considered before advancing to a clinical trial. Treatment fidelity and acceptability were moderate to high. There were no adverse events from study participation. Conclusions: Results demonstrated preliminary evidence of fidelity and acceptability of rehabilitation using hippotherapy and the equine environment for children with upper extremity neuromotor impairments. Some changes should be made to improve enrollment, retention, and outcome measure completion before advancing to a definitive trial. Trial registration: ClinicalTrials.gov identifier: NCT0653068. Trial funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Foundation for Physical Therapy Research, American Academy of Cerebral Palsy and Developmental Medicine, and Pedal With Pete Foundation.

Motor, cognitive, and socio-cognitive mechanisms explaining social skills in autism and typical development

Challenges in social functioning are considered a core criterion for diagnosing autism. Although motor skills, executive functioning (EF), and theory of mind (ToM) abilities independently affect social challenges and are interconnected, these abilities' shared contribution to the explanation of social functioning in autism remains under-investigated. To address this disparity, we examined the motor, EF, and ToM abilities of 148 autistic and non-autistic youth (ages 6-16 years), evaluating these variables' impact on social ability and their interconnections. Our mediation model exploring the contribution of motor, EF, and ToM skills explained 85% of the variance in social functioning (Social Responsiveness Scale-SRS-2). Analysis yielded a direct path from study group to SRS-2-social (typically developing-TD > autistic) and two main parallel indirect joint paths: (a) Group ➔ motor ➔ EF ➔ SRS-2-social; and (b) Group ➔ motor ➔ ToM ➔ SRS-2-social. In two secondary indirect paths, autistic children showed lower motor skills, which in turn explained their higher EF and/or ToM impairment, which in turn explained their higher social skills impairment. Put differently, our results suggest that better EF and TOM proficiency may compensate for poorer motor skills. Findings also indicated that the collective impact of motor, EF, and ToM skills on social functioning, along with the mediating role played by EF and ToM on the social-motor linkage, may contribute to understanding individual differences in the social functioning of autistic children. These conclusions call for the inclusion of motor, EF, and ToM activities into daily practices to facilitate social functioning.

A Pilot Study of Idiopathic Toe Walking: Measures and Outcomes

This pilot study sought to determine the feasibility of quantifying sensory processing, postural control, motor skill development and participation in daily life in children with idiopathic toe walking (ITW) compared to children without ITW. A nonrandomized, prospective case-control design was employed. Twenty participants were recruited. Computerized weight bearing and postural control data was successfully collected. Differences were found in forefoot/rearfoot weight bearing, balance, sensory-motor abilities and parent reported participation challenges. Sensory processing results were inconclusive. Findings can inform standardized assessment and treatment of ITW.

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.

Effects of Physical Activity on Cognition, Behavior, and Motor Skills in Youth with Autism Spectrum Disorder: A Systematic Review of Intervention Studies

The aim of this paper was to analyze the acute and chronic effects of physical activity (PA) on cognition, behavior, and motor skill in youth with autism spectrum disorder (ASD), taking into account potential confounders. In addition, it was intended to elaborate a guide of educational applications with strategies for PA use. Studies were identified in four databases from January 2010 to June 2023. A total of 19 interventional studies met the inclusion criteria. PA programs ranged from two weeks to one year in duration, with a frequency of one to five sessions per week. More than 58% of the studies showed positive effects of PA on cognition, and 45.5% on behavior and motor skill. Moderate-vigorous PA for 15-30 min has shown acute effects on cognition, general behavior, and stereotypic/repetitive behaviors in youth with ASD. A total of 9 out of 14 studies showed chronic effects on general behavior and stereotypic behaviors, and only 6 on motor skills.

Motor imagery in autism: a systematic review

Introduction

Motor Imagery (MI) is when an individual imagines performing an action without physically executing that action and is thought to involve similar neural processes used for execution of physical movement. As motor coordination difficulties are common in autistic individuals it is possible that these may affect MI ability. The aim of this systematic review was to assess the current knowledge around MI ability in autistic individuals.

Methods

A systematic search was conducted for articles published before September 2023, following PRISMA guidance. Search engines were PsycINFO, PubMed, Web of Science, Scopus, Wiley Online Library and PsyArXiv. Inclusion criteria included: (a) Original peer-reviewed and pre-print publications; (b) Autistic and a non-autistic group (c) Implicit or explicit imagery tasks (d) Behavioral, neurophysiological or self-rating measures, (e) Written in the English language. Exclusion criteria were (a) Articles only about MI or autism (b) Articles where the autism data is not presented separately (c) Articles on action observation, recognition or imitation only (d) Review articles. A narrative synthesis of the evidence was conducted.

Results

Sixteen studies across fourteen articles were included. Tasks were divided into implicit (unconscious) or explicit (conscious) MI. The implicit tasks used either hand (6) or body (4) rotation tasks. Explicit tasks consisted of perspective taking tasks (3), a questionnaire (1) and explicit instructions to imagine performing a movement (2). A MI strategy was apparent for the hand rotation task in autistic children, although may have been more challenging. Evidence was mixed and inconclusive for the remaining task types due to the varied range of different tasks and, measures conducted and design limitations. Further limitations included a sex bias toward males and the hand rotation task only being conducted in children.

Discussion

There is currently an incomplete understanding of MI ability in autistic individuals. The field would benefit from a battery of fully described implicit and explicit MI tasks, conducted across the same groups of autistic children and adults. Improved knowledge around MI in autistic individuals is important for understanding whether MI techniques may benefit motor coordination in some autistic people.

Visuomotor tracking strategies in children: associations with neurodevelopmental symptoms

Children with neurodevelopmental disorders (NDDs) often display motor problems that may impact their daily lives. Studying specific motor characteristics related to spatiotemporal control may inform us about the mechanisms underlying their challenges. Fifty-eight children with varying neurodevelopmental symptoms load (median age: 5.6 years, range: 2.7-12.5 years) performed an interactive tablet-based tracking task. By investigating digit touch errors relative to the target's movement direction, we found that a load of neurodevelopmental symptoms was associated with reduced performance in the tracking of abrupt alternating directions (zigzag) and overshooting the target. In contrast, reduced performance in children without neurodevelopmental symptoms was associated with lagging behind the target. Neurodevelopmental symptom load was also associated with reduced flexibility in correcting for lateral deviations in smooth tracking (spiral). Our findings suggest that neurodevelopmental symptoms are associated with difficulties in motor regulation related to inhibitory control and reduced flexibility, impacting motor control in NDDs.

Cognitive predictors of Social processing in congenital atypical development

According to current accounts of social cognition, the emergence of verbal and non-verbal components of social perception might rely on the acquisition of different cognitive abilities. These components might be differently sensitive to the pattern of neuropsychological impairments in congenital neurodevelopmental disorders. Here, we explored the association between social and non-social cognitive domains by administering subtests of the NEPSY-II battery to 92 patients with Intellectual and Developmental Disability (IDD). Regardless the level of intellectual functioning and presence of congenital brain malformations, results revealed that visuospatial skills predicted emotion recognition and verbal component of Theory of Mind, whereas imitation predicted the non-verbal one. Future interventions might focus on spatial and sensorimotor abilities to boost the development of social cognition in IDD.

[A review of studies on visual behavior analysis aided diagnosis of autism spectrum disorders]

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and repetitive behaviors. With the rapid development of computer vision, visual behavior analysis aided diagnosis of ASD has got more and more attention. This paper reviews the research on visual behavior analysis aided diagnosis of ASD. First, the core symptoms and clinical diagnostic criteria of ASD are introduced briefly. Secondly, according to clinical diagnostic criteria, the interaction scenes are classified and introduced. Then, the existing relevant datasets are discussed. Finally, we analyze and compare the advantages and disadvantages of visual behavior analysis aided diagnosis methods for ASD in different interactive scenarios. The challenges in this research field are summarized and the prospects of related research are presented to promote the clinical application of visual behavior analysis in ASD diagnosis.

Web-Based Exercise Interventions for Children with Neurodevelopmental Disorders

Various studies have shown the effectiveness of motor interventions for children with neurodevelopmental disorders (NDDs). Web-based interventions may provide an opportunity for remote access to effective interventions with less burden on therapists. This systematic review aimed to examine the effects of web-based exercise interventions for children with NDDs. We searched PubMed for relevant articles published in English since 1994 and included intervention studies focusing on NDDs in children aged ≤18 years, who received web-based exercise interventions. We categorized the extracted information by outcome measure and intervention type and assessed the risk of bias of the included studies. We selected five articles whose subjects had autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and developmental coordination disorder (DCD). The exercise interventions used active video games, a Zoom-based intervention, and a WhatsApp-based intervention. Three papers showed improvements in physical activity, motor function, and executive function, whereas two papers on DCD showed no improvements in motor coordination or physical activity. Web-based exercise intervention for children with ASD and ADHD may improve their motor function, executive function, and physical activity rather than for children with NDDs. An intervention may be more effective when the content of the intervention is based on objectives and symptoms, when guidance is provided by specialists, or when sufficient explanation and support are provided to parents. However, more research is needed to statistically evaluate the effectiveness of web-based exercise interventions for children with NDDs.

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.

The co-occurrence of motor and language impairments in children evaluated for autism spectrum disorder. An explorative study from Norway

BACKGROUND

Current research suggest that motor and language impairments are common and closely related in infants with autism spectrum disorder (ASD). In older children, less is known about how these impairments are related to each other.

AIMS

The current study explored the co-occurrence and potential impact of motor and language impairments in a sample of school-aged children evaluated for ASD by Norwegian specialist health services.

METHODS

Besides clinical evaluation for ASD, all participants (N = 20, mean age 10.7 (SD = 3.4) years) underwent a standardized test of motor performance (MABC-2), parent report measures of current motor (DCDQ'07), language (CCC-2), and social (SRS) skills, and a caregiver interview on everyday functioning, providing an overall impairment score (DD-CGAS).

RESULTS

The majority (85%) had motor and/or structural language deficits in addition to their social impairment. All children identified with motor impairment on both measures (39%) also had structural language deficits. Better motor performance was strongly correlated with better structural language skills (r = .618, p = .006).

CONCLUSIONS

Our findings suggest that co-occurring motor and structural language deficits should be anticipated and assessed when evaluating children for ASD. These deficits may need specific interventions that complement those targeting social skills deficits and other ASD core symptoms.

The Current View on the Paradox of Pain in Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which affects 1 in 44 children and may cause severe disabilities. Besides socio-communicational difficulties and repetitive behaviors, ASD also presents as atypical sensorimotor function and pain reactivity. While chronic pain is a frequent co-morbidity in autism, pain management in this population is often insufficient because of difficulties in pain evaluation, worsening their prognosis and perhaps driving higher mortality rates. Previous observations have tended to oversimplify the experience of pain in autism as being insensitive to painful stimuli. Various findings in the past 15 years have challenged and complicated this dogma. However, a relatively small number of studies investigates the physiological correlates of pain reactivity in ASD. We explore the possibility that atypical pain perception in people with ASD is mediated by alterations in pain perception, transmission, expression and modulation, and through interactions between these processes. These complex interactions may account for the great variability and sometimes contradictory findings from the studies. A growing body of evidence is challenging the idea of alterations in pain processing in ASD due to a single factor, and calls for an integrative view. We propose a model of the pain cycle that includes the interplay between the molecular and neurophysiological pathways of pain processing and it conscious appraisal that may interfere with pain reactivity and coping in autism. The role of social factors in pain-induced response is also discussed. Pain assessment in clinical care is mostly based on subjective rather than objective measures. This review clarifies the strong need for a consistent methodology, and describes innovative tools to cope with the heterogeneity of pain expression in ASD, enabling individualized assessment. Multiple measures, including self-reporting, informant reporting, clinician-assessed, and purely physiological metrics may provide more consistent results. An integrative view on the regulation of the pain cycle offers a more robust framework to characterize the experience of pain in autism.

Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders

We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to a developmental asynchrony and an unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in 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.

Correlation of Motor Competence and Social-Emotional Wellbeing in Preschool Children

Introduction

The relations of motor skills to different developmental domains, i.e., cognitive, emotional, and social domain, are well-documented in research on children with poor motor competence and children with disabilities. Less conclusive evidence on interaction of motor and social or emotional development can be seen in research on typically developing children. The purpose of this study was to determine a correlation between motor skills and social-emotional functioning in typically developing preschool children and to identify differences in social-emotional functioning in children with different levels of motor competence.

Methods

A total of 125 preschool children (67 boys, 58 girls, average age 5.1 years) participated in this study. To assess children’s motor skills, we used the Test of Gross Motor Development–Second Edition that measures locomotor and object-control skills. To screen child’s social and emotional functioning, we used the Ages and Stages Questionnaire–Social Emotional: Second Edition. Spearman’s correlation analysis was used to determine association between motor skills and social-emotional functioning. Difference in social-emotional functioning between groups of preschool children with High and Low motor competences was calculated using Mann-Whitney U-test.

Results

The main result of this study is weak correlation of child’s motor skills to social-emotional functioning. Furthermore, preschool children with High and Low motor competences do not differ in risk for social and emotional difficulties.

Conclusion

Further research on typically developing children is needed to have more conclusive evidence on interaction of motor and social or emotional development.

Effects of Square-Stepping Exercise on Motor and Cognitive Skills in Autism Spectrum Disorder Children and Adolescents: A Study Protocol

Individuals with autism spectrum disorder (ASD) diagnoses present not only cognitive, emotional, communicative, and social challenges but also movement issues that affect their everyday activities, learning, and leisure. The use of the square-stepping exercise (SSE), a motor program initially created to strengthen the lower limbs of older adults, is spreading because of its advantages (e.g., balance and lower limb strength improvements). A study protocol to assess the SSE effects on motor, sensory, and cognitive skills in Spanish children and adolescents between 6 and 12 years old with ASD diagnoses is presented. A randomised clinical will be performed, recruiting 52 children and adolescents with ASD who will be distributed into two groups: an experimental (n = 26) and a control (n = 26) group. The SSE sessions will be held for 9 weeks (two times per week). The main variable will be balance, which will be measured with the Movement Assessment Battery for Children 2 (MABC2), and secondary outcomes will include sensory processing, attention, and executive functions. Assessments will be carried out before and at the end of the program implementation, including an additional follow up one month later. If this program obtains positive results, it should be implemented in different settings (schools, clinics, associations, etc.) to improve the quality of movement and development in children and adolescents with ASD, as it is an easy-to-use and structured tool.

The Best of Two Different Visual Instructions in Improving Precision Ball-Throwing and Standing Long Jump Performances in Primary School Children

Two observational learning approaches have been shown to be successful in improving children's motor performances: one is "technique-focused", another is "goal-focused". In this study, we sought to compare the effectiveness of these two strategies, thus testing for the more efficient method of observational learning to enhance motor skills in primary school children. To this end, two experiments were designed. Experiment 1 involved a precision ball throwing task. Experiment 2 involved a standing long jump task. A total of 792 subjects (aged 6-11) participated in this study and were divided into technique-focus (Experiment 1 n = 200; Experiment 2 n = 66), goal-focus (Experiment 1 n = 195; Experiment 2 n = 68), and control groups (Experiment 1 n = 199; Experiment 2 n = 64). The experiments were divided into pretest, practice, and retention phases. During the practice phase, the technique-focus and goal-focus groups were given different visual instructions on how to perform the task. The results showed that children aged 10-11 belonging to the technique-focus group performed significantly better in the practice phase than both the goal-focus and the control group (p < 0.001), but only for the precision ball throwing task. These findings could be useful for training adaptation in the context of motor learning and skills acquisition.

Motor impairments in Chinese toddlers with autism spectrum disorder and its relationship with social communicative skills

OBJECTIVE

Motor impairments are prevalent in children with autism spectrum disorder (ASD) and persistent across age. Our current study was designed to investigate motor deficits in Chinese toddlers with ASD and to explore the relationships between motor deficits and social communication skills.

METHODS

For this cross-sectional study, we recruited a total of 210 Chinese toddlers with ASD aged between 18 and 36 months in the study during December 2017 to December 2020. Griffiths Developmental Scales-Chinese (GDS-C), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Communication and Symbolic Behavior Scales Developmental Profile-Infant-Toddler Checklist (CSBS-DP-ITC) were administered in these toddlers to evaluate their development, social communicative skills, and autism severity. We compared the developmental and social communicational profiles of ASD toddlers in different gross and fine motor subgroups, and explored potential associated factors. The univariate generalized linear model tested the relationship of fine and gross motor skills and social communicative skills.

RESULTS

The prevalence of gross and fine motor deficits were 59.5 and 82.5%, respectively, which are almost equivalent in boys and girls. The motor impairments tended to be more severe with age in toddlers. After adjusting for age, sex, non-verbal development quotient (DQ) and restricted, repetitive behaviors, severer gross motor impairments were significantly related to higher comparison score of ADOS-2 and higher social composite score of CSBS-DP-ITC, without interactions with other variables. Meanwhile, lower fine motor skills were associated with more deficits of social communication and higher severity of ASD, also depending on non-verbal DQ. In the lower non-verbal DQ subgroup, both fine motor deficits and restricted repetitive behaviors (RRBs) might have effects on autism symptomology.

CONCLUSION

Motor impairments are common in Chinese toddlers with ASD. Toddlers with weaker gross and fine motor skills have greater deficits in social communicative skills. Gross motor impairment might be an independent predictor of the severity of autism and social communication skills, while the effect of fine motor deficits might be affected by non-verbal DQ and RRBs of toddlers with ASD. We provide further justification for the inclusion of motor impairments in the early intervention for toddlers with ASD.

Double punch to the better than nothing: physical activity participation of adolescents with autism spectrum disorder

Participation in physical activity (PA) occurs differently in each individual. Investigating how it comes about in adolescents with autism spectrum disorder (ASD) is seen as an area that does not receive enough attention. In this paper, which was designed to get more information and contribute to the field, the participation of adolescents with ASD in PA was examined in line with the socio-ecological model through the opinions of 17 Turkish parents. Semi-structured interviews well-used to understand the perspective of parents', and as a main themes constraints and facilitating factors affecting participation of adolescents with ASD in PA were determined. When investigated in terms of intrapersonal factors, which are the first stage of the model, are examined, it is seen that ASD related problems as a constraint and experiences as a facilitator were the foremost themes. Interpersonal constraints were prejudice and family attitude while facilitators were family attitude and attitude of close surroundings. In environmental factors, the main constraints were adapted physical activity (APA) opportunities, while facilitators were neighborhood and facilities. While negative PA approaches of organizations was an institutional constraint, positive PA approach of organizations was a facilitator. In the final stages of the model, in terms of public policy, the constraint was not meeting expectations of current policies and the facilitator was improvements in policies. Consequently, it was understood that adolescents with ASD still participate in PA in some way even though they encounter many constraints when participating in physical activities, the constraints outweigh the facilitating factors.

A Longitudinal Analysis of the Relationships Between Social, Communication, and Motor Skills Among Students with Autism

Many students with autism have difficulties engaging with their classroom environments and forming friendships, which are mostly affected by deficits in social, communication, and motor skills. The Special Education Elementary Longitudinal Study (SEELS, 2000) data set was used, focusing on elementary age students with autism, to explore the longitudinal relationships between social, communication, and motor skills and the mediating role of motor skills in between communication and social skills by using structural equational modeling analyses. Results show that (a) motor skills mediate the relationship between communication and social skills in elementary school, (b) there are significant longitudinal relationships among these skills in elementary school. Increased motor skills may improve social skills for students with autism in elementary school.

The interaction of fine motor, gesture, and structural language skills: The case of autism spectrum disorder

Motor skill differences have been consistently reported in individuals with ASD. Associations between motor skill and social communication skills have been reported in both typical development (TD) and autism spectrum disorder (ASD). The current study extends these findings to characterize performance on a fine motor imitation task, probing skills as a predictor of social and communicative functioning, and co-speech gesture use. These research questions were addressed by a secondary analysis of data collected during a previous study characterizing a cohort of individuals who were diagnosed with ASD in early childhood but lost the autism diagnosis (LAD) by the time of adolescence. Fine motor imitation skills were compared between 14 individuals with LAD, 15 individuals with autism spectrum disorder (ASD), and 12 typically developing (TD) individuals. LAD and TD groups had more advanced fine motor imitation skills than the ASD group, and abilities were significantly associated with ASD symptoms and amount of gesture use (though there was a counterintuitive interaction between group and fine motor skill in the LAD and TD groups only, in which lower motor skills predicted more ASD symptoms; this relationship was of a small effect size and is likely driven by the compressed range of fine motor skills in these two groups). Findings suggest that fine motor skills normalize along with social communication skills and restricted and repetitive behaviors and interests in individuals who lose the ASD diagnosis, and that individuals with better fine motor abilities produce more co-speech gesture.

Supplementary and Premotor Aspects of the Corticospinal Tract Show Links with Restricted and Repetitive Behaviors in Middle-Aged Adults with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) show motor impairment into adulthood and risk decline during aging, but little is known about brain changes in aging adults with ASD. Few studies of ASD have directly examined the corticospinal tract (CST)-the major descending pathway in the brain responsible for voluntary motor behavior-outside its primary motor (M1) connections. In 26 middle-aged adults with ASD and 26 age-matched typical comparison participants, we used diffusion imaging to examine the microstructure and volume of CST projections from M1, dorsal premotor (PMd), supplementary motor area (SMA), and primary somatosensory (S1) cortices with respect to age. We also examined relationships between each CST sub-tract (-cst), motor skills, and autism symptoms. We detected no significant group or age-related differences in tracts extending from M1 or other areas. However, sub-tracts of the CST extending from secondary (but not primary) motor areas were associated with core autism traits. Increased microstructural integrity of left PMd-cst and SMA-cst were associated with less-severe restricted and repetitive behaviors (RRB) in the ASD group. These findings suggest that secondary motor cortical areas, known to be involved in selecting motor programs, may be implicated in cognitive motor processes underlying RRB in ASD.

Can a Community-Based Football Program Benefit Motor Ability in Children with Autism Spectrum Disorder? A Pilot Evaluation Considering the Role of Social Impairments

This non-randomised pilot study evaluated the impact of a community football program on motor ability in children aged 5-12 years with autism spectrum disorder. Sixteen children were evaluated at baseline-and-post attendance in a football program for a varied number of weeks and compared to 19 children engaging in treatment-as-usual. Primary analyses indicated a statistically significant increase in total MABC-2, aiming and catching, and balance scores for the intervention group, with no changes in scores in the comparison group. There were no changes in manual dexterity across either group. At a between group level, the changes in aiming and catching scores were significantly greater for the intervention group. Further analyses highlighted the potential importance of social impairments regarding aiming and catching.

Motor Development in Children With Autism Spectrum Disorder

Objective: This study was conducted to determine the gross and fine motor profiles of children with autism spectrum disorder compared to typically developing children. Additionally, we also assessed if the motor delay was more pronounced with increasing age. Method: This was a retrospective study involving children aged 12-60 months of age comparing motor development in children with autism spectrum disorder with typically developing children. Their developmental profile was assessed using Schedule of Growing Skills II. Descriptive statistics was used to analyse the developmental profile between the groups. Results: ASD children had significant gross motor (6.7%) and fine motor delay (38.5%) compared to typically developing children, who did not show any delay. The motor delay in ASD children was more prominent in older children. Conclusion: It is important to assess motor development in ASD children as there is significant motor delay in these children compared to typically developing children, and the delay becomes more prominent with age. Early detection of motor delay could allow provision of early intervention services to optimize developmental outcomes.

Disruptive Behavior Programs on Primary School Students: A Systematic Review

The objective of this study was to review the existing international literature on research and programs for the reduction of disruptive behavior in primary school students. For this purpose, according to PRISMA-ScR, a mixed systematic review was performed in six databases in order to obtain wide and extensive information related to the subject under study. The studies obtained were analyzed through a table which emphasized the data related to: Author(s), year, educational stage, location, objectives, instruments, and results. As for the selection of studies, the UNESCO Thesaurus and the ERIC Thesaurus terminology was used. In addition to specifying the search for studies performed between 2004 and 2020 (both inclusive), articles written in Spanish and English were selected. Furthermore, in a final phase among the articles analyzed, those that were not or did not contain intervention programs were discarded. Therefore, a total of thirty-five articles out of more than twenty thousand were analyzed in depth. The results showed that a majority of programs were implemented in the primary education stage, as well as a predominance of the use of instruments, such as questionnaires and observation charts. In addition, it is important to underline that 77.14% of the programs analyzed were effective, hence, they met the proposed objectives. In summary, although the number of intervention programs for the reduction of disruptive behavior that can be found in the international scientific literature is growing, there is still a long way to go in order to create a large network that can serve as a foundation for interventions in primary education students.

Exploring Caregiver Perspectives of Social and Motor Skills in Children With Autism Spectrum Disorder and the Impact on Participation

Participation is a key aspect of quality of life and is essential for children's well-being, yet children with disabilities are at risk for lower participation in social activities. For children with autism spectrum disorder (ASD), social skills may present a significant obstacle for participation in activities of daily life; however, motor skill development may also serve an important contributing factor. Nevertheless, the link between social and motor skills in children with ASD is not fully understood. The current research implemented semistructured interviews to garner descriptive insights from caregivers (N = 17) into the social and motor skills of 5- to 9-year-old children with ASD and the impact on participation in social activities. A constant comparative method was used to generate a coherent and thematic representation of caregivers' experiences. Thematic analysis revealed core consistencies in three areas: (1) caregivers viewed participation differently than their children; (2) participation levels of children with ASD are context specific; (3) challenges with social skills were perceived to present a greater obstacle to participation than motor skills. Overall, the notion that ASD is a heterogeneous disorder was made very apparent. Although caregivers believe there to be immense value in current treatment and intervention options, the availability and access to such options was a major barrier. The effectiveness of intervention programming designed to increase participation is contingent on understanding factors that affect participation. Implications concerning caregivers' perspectives are discussed.