The course and prognostic capability of motor difficulties in infants showing early signs of autism

Abstract

Delays within the motor domain are often overlooked as an early surveillance marker for autism. The present study evaluated motor difficulties and its potential as an early predictive marker for later autism likelihood in a cohort of infants (N = 96) showing early behavioral signs of autism aged 9–14 months. The motor domain was evaluated using the motor subscales of the Mullen Scales of Early Learning at baseline, and at a 6‐month follow‐up. The Autism Diagnostic Observation Schedule – Toddler Module (ADOS‐T) was completed at follow‐up as a measure of autism likelihood. Motor difficulties were common at baseline, with 63/96 (65.6%) infants scoring very low or below average in the gross motor domain and 29/96 (30.2%) in the fine motor domain. At follow‐up, gross motor difficulties had resolved for many, with 23/63 (36.5%) infants maintaining these difficulties. Fine motor difficulties resolved in fewer infants, with 20/29 (69.0%) continuing to present with fine motor delays at follow‐up. Adjusted linear regression models suggested that fine motor scores at baseline (β = −0.12, SE = 0.04) and follow‐up (β = −0.17, SE = 0.05) were associated with higher ADOS‐T scores; with difficulties across both timepoints (β = 5.60, SE = 1.35) the strongest (largest in magnitude) association with ADOS‐T scores of the predictors examined. Motor difficulties are prominent in children displaying emerging signs of autism, with persistent fine motor difficulties predictive of the developing autism phenotype. The findings indicate the potential clinical value of including evaluation of motor skills within early autism surveillance measures. Lay Summary This prospective study evaluated motor development over a 6‐month period in infants showing early behavioral signs of autism. Atypical motor development was a common feature of infants showing early signs of autism and persistent fine motor difficulties were predictive of the emerging autism phenotype.

Early Motor Signs in Autism Spectrum Disorder

“…Lower fine motor skills at baseline and follow-up were associated with greater severity of autism signs. The results underline the potential clinical value of motor skills’ evaluation within early autism screening [ 21 ]. Sasayama et al studied 1067 children who had been screened for ASD at the age of 18 months.…”

A Review of Early Motor Issues in Young Children With Autism Spectrum Disorder

“…When the development of children at high risk for ASD is followed, children with early motor delays are more likely to have delays in communication (Bhat et al, 2011), expressive language (Choi et al, 2018; LeBarton & Iverson, 2013; LeBarton & Landa, 2019), and pragmatic language (Stevenson, Lindley, & Murlo, 2017) and are more likely to receive an ASD diagnosis (LeBarton & Landa, 2019). Research suggests that early fine motor skills may have a stronger predictive value than gross motor skills at predicting a 36-month severity score on the Autism Diagnostic Observation Schedule (ADOS; Iverson et al, 2019) and expressive language delays (Choi et al, 2018; Hellendoorn et al, 2015; LeBarton & Iverson, 2013; Licari et al, 2021).…”

Heterogeneity of autism symptoms in community‐referred infants and toddlers at elevated or low familial likelihood of autism

“…This study included community‐referred children who presented with autism symptoms and were judged by expert clinicians to have a high likelihood of meeting autism diagnostic criteria, a sampling approach that has been employed in numerous studies of autism in infant‐ and toddler‐aged populations (e.g., Kim et al, 2018; Licari et al, 2021; Pierce et al, 2019; Whitehouse et al, 2019). Recruiting infants and toddlers with suspected autism from the community allowed us to include a sample likely more reflective of the demographic (e.g., racial, ethnic), etiological, and phenotypic diversity of autistic children and families sampled from the general population.…”