Conference Summary: The International Society for Autism Research (INSAR) is the largest autism research conference in the world. This year’s conference took place May 11 – 14 and was a hybrid conference with both remote and in-person events being held in Austin, Texas. There has been a push in recent years to elevate autistic voices and the “nothing about us without us” movement has led to additional events to provide a platform for autistic individuals to share their perspectives. Additional events about culture, diversity, and expanding the number of autistic individuals who are collaborating as equal partners in research projects. Topics for research panel sessions are chosen based on proposals around the world that are in line with the stated goals of the INSAR community.
Introduction: Motor skills, including both motor planning and motor functioning, have been associated with autism but are not considered as part of the core diagnostic criteria. These motor difficulties often are observable long before a person may be assessed and diagnosed with autism. Previous research has estimated that between 35% to 80% of autistic individuals have persistent motor impairment issues that can impact them across their lifespan, compared to the roughly 5% in the neurotypical population. In this research summary, two INSAR presentations are highlighted to speak to what we know about motor skill problems, and how children can be screened for them.
1) Persistent Barriers to Motor Assessment and Intervention, Despite Early Caregiver Awareness of Motor Symptoms
2) Value of the Developmental Coordination Disorder Questionnaire (DCD-Q) As a Screener for Co-Occurring Motor Problems in Children with Autism Spectrum Disorder
Presentation 1) Miller, H. L., University of Michigan
Presentation 2) Van Damme, T., Katholieke Universiteit Leuven
Presentation 1) Fears, N. E., University of Michigan; Luna-Smit, A, University of North Texas Health Science Center; S. Mupparap, S., University of North Texas Health Science Center; Ganesh, A., University of North Texas Health Science Center; Martinez, K., University of North Texas Health Science Center; Sherrod, G. M., University of Alabama at Birmingham; and Bugnariu, N. L., University of the Pacific
Presentation 2) No additional authors.
Background: Motor impairments can present in a variety of ways. Gross motor skills require the use of the large muscle groups necessary for actions like crawling, walking, and running. Fine motor skills require the use of the smaller
muscles necessary for actions like grasping or writing. Coordination means timing the use of different muscle groups to complete an action smoothly and without ‘clumsiness’. Motor planning refers to the coordinated effort to carry out
an act in the correct sequence. It involves deciding what you want to do (e.g., put on a jacket), figuring out the sequence of actions to do it (e.g., take jacket off a clothes hanger, unzip the jacket, put your arms through each sleeve, and zip it
back up), and carrying out the plan smoothly. Difficulties with motor planning can occur with both gross and fine motor skills.
Some examples of activities that can be difficult for individuals with motor skills deficiencies are:
Throwing a ball
Jumping over objects
Hitting a ball with a bat or racket
Getting dressed independently
Using the appropriate amount of pressure to write
Going down the stairs
Buttoning a shirt
Tying up shoelaces
Sitting up for long periods of time
If individuals struggle with multiple aspects of motor skills from an early age, they may be diagnosed with Developmental Coordination Disorder (DCD). This condition makes it hard to learn to coordinate muscle groups to perform certain actions. It is
not a learning disability but can impact school performance when the ability to use coordination and motor skills is necessary. ADHD is the most common co-occurring condition with DCD, but autism and sensory processing disorders are also associated
INSAR presentations: How does DCD relate to autism?
Multiple research studies have indicated that motor problems in autism first show up in infancy and early childhood and do not go away as individuals age. The earliest indications of motor skills difficulties begin as delays in gross and fine motor skill
milestones (e.g., an infant does not master grasping a small object until later than their peers). As an individual ages into middle and late childhood, these motor skills difficulties may present as general ‘clumsiness’ and difficulty
with issues with gestures and handwriting. In adolescence and young adulthood, these motor difficulties may appear as unsteadiness while moving or struggling with the coordination required to master some daily living tasks (e.g., loading a dishwasher
without banging/breaking dishes). Finally, as autistic adults with motor difficulties enter their elder years, these motor difficulties can lead to increased rates of falls and injury, which can have long-term effects on mobility
and general quality of life. Dr. Miller concluded that it is important to understand how each individual struggles with motor skills and provide support and interventions tailored to their needs to prevent long-term injuries as a person ages. Dr.
Van Damme indicated a questionnaire, as described below, as commonly used to assess DCD. This questionnaire was conveyed as helpful in identifying children on the autism spectrum who also had DCD. This tool can be used with more than just the neurotypical
population (see ‘How is DCD diagnosed?’ below).
What causes motor skill difficulties in DCD?
There can be several reasons that a person may have trouble with their gross and fine motor skills, coordination, and/or motor planning. A key feature of DCD is that these issues are present early on and do not go away as a person ages. Some studies have indicated that differences in the functional connectivity (e.g., how different areas of the brain communicate and work together) are common in individuals with DCD. Difficulties with executive functioning (e.g., organization skills, planning out complex activities by breaking them down into smaller steps) and sensory processing differences are also associated with DCD. DCD is more common in males or those who were born prematurely. Children with DCD are more likely to have symptoms of anxiety and depression. There is also believed to be a genetic component as DCD can run in families.
How is DCD diagnosed?
To be diagnosed with DCD, an individual often needs to be assessed by a developmental paediatrician or an occupational therapist (OT). The specialist will likely administer the Movement Assessment Battery for Children-2 (MABC-2), which assesses both gross
and fine motor skills. They will also often take a thorough history and administer parent questionnaires. The most commonly used questionnaire for children ages 5-15 is the Developmental Coordination Disorder Questionnaire (DCDQ).
Total scores on the DCDQ are broken down into three possible categories: Indication of DCD, Suspect for DCD, and Probably not DCD. When scoring, Indication of DCD and Suspect for DCD are collapsed together (e.g., the score does not give a cut-off between these two categories) so that an individual whose questionnaire scores are within a range, is recommended to seek an official assessment. This is to avoid potentially missing or not diagnosing an individual with DCD.
The scores are interpreted differently depending on the age of the child:
Probably not DCD: 47-75
Indication of, or Suspect for, DCD: 15-46
Probably not DCD: 56-75
Indication of, or Suspect for, DCD: 15-55
Probably not DCD: 58-75
Indication of, or Suspect for, DCD: 15-57
You can administer and score the DCD yourself:
What can I do with this information?
While DCD is often lifelong and there is no cure, there are some treatments that have shown success in improving daily living skills and reducing accidents and injuries:
Occupational Therapy: Working with an OT with a background in DCD can help individuals learn to master fine and gross motor skills. OTs can also help to break down complex tasks into smaller steps to promote mastery of skills for daily living.
Physiotherapy: Physiotherapists can help develop balance and muscle tone, especially core muscles that are important for maintaining posture.
Physical Activity: Encouraging children with DCD to participate in sports and activities that help to develop movement skills can be a fun way to improve motor skills. Some children respond well to sports that do not require complex actions or fine motor
skills. Swimming, martial arts, horseback riding, and track and field all offer opportunities to practice different types of motor activities in different sensory environments.
Music Therapy: Learning a musical instrument can also be a fun way to encourage children to work on their gross and fine motor skills. It is important to try a number of instruments as the weight, the way the instrument is held, and requirements for certain
gross or fine motor skills make some instruments a better fit than others. Making sure it is an instrument that the child is motivated to continue learning is an important factor in predicting whether a given musical instrument will be a successful
way to develop motor skills.
Fine Motor Skills Activities: Creative writing, painting, and gardening are examples of activities that can encourage the use of fine motor skills.
Gross Motor Skills Activities: Trampolines, bubble play, dancing, and tricycles/bicycles/scooters are fun activities that require the use and coordination of multiple large muscle groups.
INSAR 2022 Presentation 1: Miller, H. L.; Fears, N. E.; Luna-Smit, A.; S. Mupparap, S; Ganesh, A.; Martinez, K.; Sherrod, G. M.; & Bugnariu, N. L., “Persistent Barriers to Motor Assessment and Intervention, Despite Early Caregiver Awareness
of Motor Symptoms”. May 13, 2022
INSAR 2022 Presentation 2: Van Damme, T., “Value of the Developmental Coordination Disorder Questionnaire (DCD-Q) As a Screener for Co-Occurring Motor Problems in Children with Autism Spectrum Disorder”. May 13, 2022
Caçola, P.; Miller, H. L.; & Williamson, P. O. (2017). Behavioral comparisons in autism spectrum disorder and developmental coordination disorder: a systematic literature review. Research in autism spectrum disorders, 38,
Karras, H.C.; Morin, D.N.; Gill, K.; Izadi-Najafabadi, S.; & Zwicker, J.G. Health-related quality of life of children with developmental coordination disorder. Res Dev Disabil 2019 84:85-95.
Zwicker, J.G.; Missiuna, C.; Harris, S.R.; & Boyd, L.A. Developmental coordination disorder: A review and update. Eur J Paediatr Neurol 2012;16(6):573-81.