Motor Abilities in Infants at Risk for Autism

Pam Versfeld    Update Jan 2018

Piven, J., Elison, J. T., & Zylka, M. J. (2017). Toward a conceptual framework for early brain and behavior development in autism. Molecular Psychiatry, 22(10), 1385–1394.

Studies of infant siblings of older autistic probands, who are at elevated risk for autism, have demonstrated that the defining features of autism are not present in the first year of life but emerge late in the first and into the second year. A recent longitudinal neuroimaging study of high-risk siblings revealed a specific pattern of brain development in infants later diagnosed with autism, characterized by cortical surface area hyper-expansion in the first year followed by brain volume overgrowth in the second year that is associated with the emergence of autistic social deficits. Together with new observations from genetically defined autism risk alleles and rodent model, these findings suggest a conceptual framework for the early, post-natal development of autism. This framework postulates that an increase in the proliferation of neural progenitor cells and hyper-expansion of cortical surface area in the first year, occurring during a pre-symptomatic period characterized by disrupted sensorimotor and attentional experience, leads to altered experience-dependent neuronal development and decreased elimination of neuronal processes. This process is linked to brain volume overgrowth and disruption of the refinement of neural circuit connections and is associated with the emergence of autistic social deficits in the second year of life. A better understanding of the timing of developmental brain and behavior mechanisms in autism during infancy, a period which precedes the emergence of the defining features of this disorder, will likely have important implications for designing rational approaches to early intervention.

De Moraes, Í. A. P., Massetti, T., Crocetta, T. B., da Silva, T. D., de Menezes, L. D. C., Monteiro, C. B. de M., & Magalhães, F. H. (2017). Motor learning characterization in people with autism spectrum disorder: A systematic review. Dementia & Neuropsychologia, 11(3), 276–286.

A total of 42 studies were identified; 33 articles were excluded because they did not meet the inclusion criteria. Data were extracted from nine eligible studies and summarized.

We concluded that although individuals with ASD showed performance difficulties in different memory and motor learning tasks, acquisition of skills still takes place in this population; however, this skill acquisition is related to heterogeneous events, occurring without the awareness of the individual.

Estes A, Zwaigenbaum L, Gu H, et al. Behavioral, cognitive, and adaptive development in infants with autism spectrum disorder in the first 2 years of life. Journal of Neurodevelopmental Disorders. 2015;7(1):24.

To delineate the early progression of autism spectrum disorder (ASD) symptoms, this study investigated developmental characteristics of infants at high familial risk for ASD (HR), and infants at low risk (LR).

Participants included 210 HR and 98 LR infants across 4 sites with comparable behavioral data at age 6, 12, and 24 months assessed in the domains of cognitive development (Mullen Scales of Early Learning), adaptive skills (Vineland Adaptive Behavioral Scales), and early behavioral features of ASD (Autism Observation Scale for Infants). Participants evaluated according to the DSM-IV-TR criteria at 24 months and categorized as ASD-positive or ASD-negative were further stratified by empirically derived cutoff scores using the Autism Diagnostic Observation Schedule yielding four groups: HR-ASD-High, HR-ASD-Moderate (HR-ASD-Mod), HR-ASD-Negative (HR-Neg), and LR-ASD-Negative (LR-Neg).

Results: The four groups demonstrated different developmental trajectories that became increasingly distinct from 6 to 24 months across all domains. At 6 months, the HR-ASD-High group demonstrated less advanced Gross Motor and Visual Reception skills compared with the LR-Neg group. By 12 months, the HR-ASD-High group demonstrated increased behavioral features of ASD and decreased cognitive and adaptive functioning compared to the HR-Neg and LR-Neg groups. By 24 months, both the HR-ASD-High and HR-ASD-Moderate groups demonstrated differences from the LR- and HR-Neg groups in all domains.

Conclusions: These findings reveal atypical sensorimotor development at 6 months of age which is associated with ASD at 24 months in the most severely affected group of infants. Sensorimotor differences precede the unfolding of cognitive and adaptive deficits and behavioral features of autism across the 6- to 24-month interval. The less severely affected group demonstrates later symptom onset, in the second year of life, with initial differences in the social-communication domain

Lloyd, M., MacDonald, M., & Lord, C. (2013). Motor Skills of Toddlers with Autism Spectrum Disorders. Autism : The International Journal of Research and Practice, 17(2), 133–146. 

With increased interest in the early diagnosis and treatment of children with autism spectrum disorders (ASD), more attention has been called to the motor skills of very young children with ASD. This study describes the gross and fine motor skills of a cross-sectional group of 162 children with ASD between the ages of 12 and 36 months, as well as a subset of 58 children followed longitudinally. Gross motor and fine motor age equivalent scores were obtained for all children. A 'motor difference' variable was calculated for each child's gross and fine motor skills by taking the absolute difference of the children's age equivalent motor score and their respective chronological age. In Study 1 (the cross-sectional analysis), ANCOVA (co-varied for nonverbal problem solving) revealed significant group differences in the gross motor and fine motor age difference variables. Post-hoc analysis revealed that gross motor and fine motor differences became significantly greater with each 6-month period of chronological age. In Study 2, 58 children were measured twice, an average of 12 months apart. Results indicate that the gross motor and fine motor difference scores significantly increased between the first and second measurements. The importance of addressing motor development in early intervention treatments is discussed.


Active play facilitates the development of motor skills, social skills, an understanding of the world, daily living skills, and adaptive behaviour; it also provides a unique opportunity for young children to be physically active and play games with peers (Pellegrini & Smith, 1998;Ridgers, Stratton, & Fairclough, 2006; Sutera et al., 2007).

Children with ASD, by definition, have difficulties in the social domain, thereby limiting their time engaged in play, with or without other children (Dewey, Lord, & Magill, 1988).

The children with ASD in this study achieved their motor milestones within typical ranges which is similar to the findings of other studies (Dawson, Osterling, Meltzoff, & Kuhl, 2000; Ozonoff, et al., 2008). However as the toddlers with ASD got older their fundamental motor skills fell significantly behind what would be expected for their chronological age.

Fundamental gross motor skills are complex and require coordination, motor planning and control. These skills are often learned through imitation in social contexts. We hypothesize that the slowing of gross motor development found in this study is partly due to the fact that gross motor skills are commonly explored and discovered during self-directed or self-regulated learning both with and without peers during play. This type of play and social engagement is a challenge for children with ASD. It is also possible that tactile sensitivities and/or aversions could contribute to the delays in fundamental motor skills. Therefore we propose that the limitations in motor proficiency demonstrated by the toddlers in this study may create a cycle where poor motor skills constrain social interactions, and poor social interactions constrain motor skill development.

The results of both the cross-sectional analysis and the longitudinal analysis also indicate that fine motor skills are also delayed in children with ASD and the children fall further behind as they get older. It is not clear why children with ASD have poor fine motor skills, but the impact on early learning opportunities and daily living skills is not trivial (Jasmin, et al., 2009).

It is possible that tactile sensitivities and an overall lack of social imitation contribute to these fine motor delays; however, the relative contributions of social and imitative deficits to fine motor skills is far from clear. This is an area that requires further study and emphasis in early interventions for children with ASD.

  • Jasmin E, Couture M, McKinley P, Reid G, Fombonne E, Gisel E. Sensori-motor and daily living skills of preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders.2009;39(2):231–241.
  • See original article for other references

Flanagan JE, Landa R, Bhat A, Bauman M. Head lag in infants at risk for autism: a preliminary study. Am J Occup Ther. 2012 Sep-Oct;66(5):577-85. doi: 10.5014/ajot.2012.004192. PubMed PMID: 22917124.

OBJECTIVE.Poor postural control during pull-to-sit is a predictor of developmental disruption in cerebral palsy and preterm populations but has not been examined in infants at risk for autism. We examined the association between head lag during pull-to-sit at age 6 mo and autismrisk status. METHOD.High-risk participants were siblings of children with autism. We studied one sample of 40 high-risk infants prospectively from 6-36 mo and obtained diagnostic classifications of autism or no autism. We conducted a subsequent between-group comparison with a new sample of 20 high-risk and 21 low-risk infants. RESULTS.Head lag was significantly associated with autism spectrum disorder at 36 mo (p = .020) and was more frequently observed in high-risk than in low-risk infants (p = .018). CONCLUSION.Head lag with other alterations in early development may be associated with autism risk and may serve as an early indicator of neurodevelopmental disruption. Results have clinical implications for occupational therapists in early intervention practice.  Access article via Research Gate

Libertus K, Sheperd KA, Ross SW, Landa RJ. Limited fine motor and grasping skills in 6-month-old infants at high risk for autism. Child Dev. 2014 Nov-Dec;85(6):2218-31. Full text 

Atypical motor behaviors are common among children with autism spectrum disorders (ASD). However, little is known about onset and functional implications of differences in early motor development among infants later diagnosed with ASD. Two prospective experiments were conducted to investigate motor skills among 6-month-olds at increased risk (high risk) for ASD (N1  = 129; N2  = 46). Infants were assessed using the Mullen Scales of Early Learning (MSEL) and during toy play. Across both experiments, high-risk infants exhibited less mature object manipulation in a highly structured (MSEL) context and reduced grasping activity in an unstructured (free-play) context than infants with no family history of ASD. Longitudinal assessments suggest that between 6 and 10 months, grasping activity increases in high-risk infants.

Purpura, G., Costanzo, V., Chericoni, N., Puopolo, M., Scattoni, M. L., Muratori, F., & Apicella, F. (2017). Bilateral Patterns of Repetitive Movements in 6- to 12-Month-Old Infants with Autism Spectrum Disorders. Frontiers in Psychology, 8, 1168. Full text 

Aim: Some patterns of repetitive movements and their frequency have been proved to distinguish infants with Autism Spectrum Disorders (ASD) from infants with Typical Development (TD) and Developmental Delay (DD) from 12 months of life on. The purpose of this study is to investigate if a specific repertoire of repetitive movements is present earlier in life, and if their higher rate and duration could differentiate infants with ASD from infants with DD and TD aged between 6 and 12 months.

Method: We conducted a retrospective analysis of video-clips taken from home videos to compare the frequency and the duration of Repetitive Movement Episodes (RMEs) in a sample of 30 children equally distributed among the three groups.

Results: Significantly higher total scores in bilateral RMEs with arms, hands, fingers, and lower limbs were found to distinguish ASD infants from both DD and TD infants, with a satisfactory diagnostic efficiency. No significant difference was found between the distributions of unilateral RMEs between ASD and DD/TD.

Interpretation: Results indicate the presence at this age of an ASD-specific pattern of bilateral repetitive movements. We hypothesize a continuum between this pattern and the lack of variability in finalized and communicative movements and gestures observed in children with ASD during the second year of life.

Serdarevic F, Ghassabian A, van Batenburg-Eddes T, White T, Blanken LME, Jaddoe VWV, Verhulst FC, Tiemeier H. Infant muscle tone and childhood autistic traits: A longitudinal study in the general population. Autism Res. 2017 May;10(5):757-768. doi: 10.1002/aur.1739. Epub 2017 Feb 9. PubMed PMID: 28181411; PubMed Central PMCID: PMC5444969.

In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistictraits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were >98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P < 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017, 10: 757-768. © 2017