Most autistic people — 87 percent, according to the latest estimate — have some sort of motor difficulty, ranging from an atypical gait to problems with handwriting. These issues are distinct from the repetitive behaviorsconsidered to be a hallmark of autism. And yet, despite their prevalence, motor problems are not considered a core trait of autism, because they also occur with other conditions, such as Down syndrome, cerebral palsy and attention deficit hyperactivity disorder.
Here, we describe what experts know about the causes, characteristics and consequences of motor difficulties, which they say are among the least understood and most neglected aspects of autism. They also call on researchers to better assess motor difficulties in autistic people and for clinicians to treat these problems, especially because motor setbacks may have consequences far beyond simply impeding movement.
What types of motor issues do autistic people have?
They may have gross-motor problems, such as a clumsy, uncoordinated gait; and difficulties with fine-motor control, such as manipulating objects and writing. Some may have trouble coordinating movements between the left and right side of the body among different limbs, making it difficult to do actions like pumping their legs on a swing, jumping, skipping or hopping. Others may have low muscle tone and problems maintaining their posture or balance. Still others seem to have trouble with actions requiring hand-eye coordination, such as catching a ball or imitating the movements of others, and with planning a series of movements or gestures, known as praxis. These difficulties can range from mild to severe and can impact any motor system of the body.
At what age do motor issues start?
They can appear in infancy. For instance, 1-month-old infants who are later diagnosed with autism tend to move their arms less than typical infants do. By about 4 months of age, a typical child can keep her head in line with her shoulders when pulled up into a sitting position, but a baby with autism often lacks that strength, and her head will flop back. And at 14 months — an age when most typical children are able to walk — autistic children may still be unable to stand. Other motor issues can include struggling to grasp objects or sit up, and not clapping and pointing.
How are motor problems linked to genetic factors that influence autism?
Some mutations that predispose people to autism may also contribute to motor issues. For example, every one-month delay in beginning to walk increases a child’s odds of having a spontaneous mutation in an autism gene by 17 percent, according to a 2017 study. And some ‘syndromic’ forms of autism — those that have a single genetic cause — include particular motor issues among their defining characteristics: People with Phelan-McDermid syndrome often have low muscle tone, and children with dup15q syndrome tend to have a characteristic gait.
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