A further study of relations between motor impairment and social communication, cognitive, language, functional impairments, and repetitive behavior severity in children with ASD using the SPARK study dataset

Abstract

Motor impairments are pervasive and persistent in children with autism spectrum disorder (ASD) throughout childhood and adolescence. Based on recent studies examining motor impairments in children with ASD between 5 and 15 years (i.e., SPARK study sample), 87–88% of this population is at‐risk for a motor impairment, these problems persisted until 15 years, and related to their core (social communication skills and repetitive behaviors [RBs]) and comorbid (language, cognitive, and functional) impairments. Persistent motor impairments extending into adolescence/adulthood could negatively impact their independent daily living skills, physical fitness/activity levels, and physical/mental health. While multiple studies have examined relations between motor dimensions and core/comorbid impairments in young children with ASD, few studies have examined such relations in school‐age children/adolescents with ASD. This paper conducts a further multidimensional study of which motor domains (i.e., gross‐motor including visuo‐motor or multilimb coordination/planning, fine motor [FM] or general coordination [GC] skills) best distinguish subgroups of school‐age children/adolescents with ASD and help predict core and comorbid impairments after accounting for age and sex. Visuomotor, FM and certain GC skills were better at explaining variations in/predicting social communication impairments whereas FM skills were slightly better at explaining variations in/predicting RB severity. Multilimb coordination/planning and FM skills explained variations in/predicted cognitive delays whereas visuomotor and FM skills explained variations in and better predicted language delays. All three motor dimensions explained variations in/predicted functional delays. This study provides further evidence for inclusion of motor impairments within the ASD definition (criteria or specifiers). Lay Summary Gross‐motor skills were related to social communication and functional delays of children with ASD (visuomotor skills related to language delays and multilimb coordination/planning skills related to cognitive delays). Fine‐motor skills were related to repetitive behavior severity, language, cognitive, and functional delays in ASD. Diagnosticians should recommend systematic motor screening, further evaluations, and treatments for children at‐risk for and diagnosed with ASD. Motor advocacy and enhanced public/clinical community awareness is needed to fulfill the unmet motor needs of children with ASD.

Insufficient evidence for inclusion of motor deficits in the ASD diagnostic criteria: A response to Bhat (2021)

“…Dr. Bhat concluded that these findings highlight, "the need to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD, and the need for appropriate motor screening and assessment of children with ASD" (Bhat, 2021, p. 202). She recently reiterated this claim in a follow-up publication using the same sample (Bhat et al, 2022). While we agree with the recommendation regarding screening and assessment of motor problems in children with ASD (as well as all children), we do not agree that there is enough evidence to support inclusion of motor impairments within the ASD definition.…”

Motor symptoms in the ASD diagnostic criteria: A conservative perspective

“…In response to Bhat's call for inclusion of motor deficits in ASD diagnostic criteria (Bhat, 2021;Bhat et al, 2022), Bishop et al (2022) take the conservative stance that no such extension can be justified in the absence of compelling evidence for motor deficits as a "core" feature. Bishop et al argue that Bhat's analysis of the SPARK data set fails to meet this bar because it does not prove that motor deficits might not be more parsimoniously explained by comorbid intellectual disability, 1 and because it depends on the Developmental Coordination Disorder Questionnaire (DCDQ), a parent-report screener which can confound motor skills with social participation in motor activities.…”

Supporting the need for the motor domain to be included in the definition of autism spectrum disorder: A response to Bishop et al.'s critique of Bhat (2021)

“…We are writing to continue the dialog from Bishop et al (2022) and Bhat (2022) about the inclusion of the motor domain in future autism spectrum disorder (ASD) definitions. At the center of this dialog are a series of papers based on the Simons Powering Autism Research (SPARK) database showing the pervasiveness of motor impairments in youth on the autism spectrum based on the Developmental Coordination Disorder-Questionnaire (DCD-Q; Bhat, 2020;Bhat, 2021;Bhat et al, 2022). Within the large SPARK sample (n's > 10,000), more than 85% of youth on the autism spectrum exhibited DCD-Q scores consistent with elevated risk of motor impairment (Bhat, 2020;Bhat, 2021;Bhat et al, 2022;Ketcheson et al, 2021).…”

“…At the center of this dialog are a series of papers based on the Simons Powering Autism Research (SPARK) database showing the pervasiveness of motor impairments in youth on the autism spectrum based on the Developmental Coordination Disorder-Questionnaire (DCD-Q; Bhat, 2020;Bhat, 2021;Bhat et al, 2022). Within the large SPARK sample (n's > 10,000), more than 85% of youth on the autism spectrum exhibited DCD-Q scores consistent with elevated risk of motor impairment (Bhat, 2020;Bhat, 2021;Bhat et al, 2022;Ketcheson et al, 2021). We agree with Bhat that these results provide evidence that warrants the consideration of motor impairments as a diagnostic criterion for ASD.…”

“…Another criticism from Bishop et al was the lack of validity of the DCD-Q for youth on the autism spectrum. As pointed out by Bhat (2022), the DCD-Q has been validated in smaller samples of youth on the autism spectrum, with acceptable concurrent validity with the Movement-Assessment Battery for Children (MABC; Green et al, 2009;van Damme et al, 2021) and strong internal consistency (Bhat, 2021;Bhat et al, 2022). The strength of the DCD-Q is the ability to use the questionnaire in surveillance studies, like SPARK, to capture large numbers of youth on the autism spectrum.…”