Paquet Aude, Olliac Bertrand, Bouvard Manuel-Pierre, Golse Bernard, Vaivre-Douret Laurence
Faculty of Medicine, Paris Descartes University, Sorbonne Paris-CitéParis, France; Department of Child Psychiatry, AP-HP Necker-Enfants Malades University HospitalParis, France; Institut National de la Santé Et de la Recherche Médicale UMR 1018 and CESP, Universities of Paris-Saclay and Paris-Sud, UVSQVillejuif, France; Department of Child and the Adolescent Psychiatry, Esquirol HospitalLimoges, France.
Department of Child and the Adolescent Psychiatry, Esquirol HospitalLimoges, France; INSERM UMR 1094, Tropical Neuroepidemiology, University of LimogesLimoges, France.
Front Psychol. 2016 Sep 12;7:1292. doi: 10.3389/fpsyg.2016.01292. eCollection 2016.
Altered motor performance has been described in Autism Spectrum Disorders (ASD) with disturbances in walking; posture, coordination, or arm movements, but some individuals with ASD show no impairment of motor skills. The neuro-developmental processes that underpin the performance of neuro-psychomotor functions have not been widely explored, nor is it clear whether there are neuro-psychomotor functions specifically affected in ASD. Our objective was to focus on the semiology of motor disorders among children with ASD using a neuro-developmental assessment tool.
Thirty-four children with ASD, with or without intellectual deficit (ID) were recruited in a child psychiatry department and Autism Resource Centers. Initial standard evaluations for diagnosis (psychiatric; psychological; psychomotor) were supplemented by a standardized assessment battery for neuro-developmental psychomotor functions (NP-MOT).
The results of some NP-MOT tests differed between children with ASD with ID and those without. However, on the NP-MOT battery, neither of the two groups did well in the bi-manual and finger praxia tests (36 and 52% respectively failed). Manual and digital gnosopraxia showed some deficit (63 and 62% respectively failed). Postural deficits were found in tests for both static equilibrium (64%) and dynamic (52%). There were also difficulties in coordination between the upper and lower limbs in 58% of children. We found 75% failure in motor skills on the M-ABC test. Concerning muscular tone, significant laxity was observed in distal parts of the body (feet and hands), but hypertonia was observed in the proximal muscles of the lower limbs (reduced heel-ear angle).
The results of manual and digital gnosopraxia tests point to a planning deficit in children with autism. A gesture programming deficit is also highlighted by the poor results in manual praxis, and by failures in the M-ABC tests despite prior training of the child. However, concerning global motor function, a significant difference was observed between children with and without ID. Our findings suggest a semiology of tone deregulation between proximal versus distal muscles, indeterminate tonic laterality, postural control deficit (proprioceptive), impairment of inter-hemispheric coordination (corpus callosum), and neurological soft signs such asdysdiadochokinesia, which leads us to hypothesize a general impairment of motor functions.
自闭症谱系障碍（ASD）患者存在运动表现改变，包括行走、姿势、协调或手臂运动方面的障碍，但部分ASD患者运动技能并无损害。支撑神经心理运动功能表现的神经发育过程尚未得到广泛研究，ASD中是否存在特定受影响的神经心理运动功能也尚不明确。我们的目标是使用神经发育评估工具，聚焦于ASD儿童运动障碍的症状学。
在儿童精神科和自闭症资源中心招募了34名有或无智力缺陷（ID）的ASD儿童。诊断的初始标准评估（精神病学、心理学、心理运动学）由神经发育心理运动功能标准化评估量表（NP-MOT）补充。
有ID的ASD儿童和无ID的ASD儿童在一些NP-MOT测试结果上存在差异。然而，在NP-MOT量表上，两组在双手和手指运用测试中表现均不佳（分别有36%和52%的儿童未通过）。手部和指部认识不能测试显示出一些缺陷（分别有63%和62%的儿童未通过）。在静态平衡（64%）和动态平衡（52%）测试中均发现姿势缺陷。58%的儿童在上下肢协调方面也存在困难。我们发现M-ABC测试中有75%的儿童运动技能未通过。关于肌张力，在身体远端部位（足部和手部）观察到明显松弛，但在下肢近端肌肉中观察到张力亢进（跟耳角减小）。
手部和指部认识不能测试结果表明自闭症儿童存在计划缺陷。手部运用测试结果不佳以及尽管儿童之前接受过训练但M-ABC测试仍未通过，也凸显了手势编程缺陷。然而，关于整体运动功能，有ID和无ID的儿童之间观察到显著差异。我们的研究结果表明，近端与远端肌肉之间存在肌张力失调症状学、不确定的紧张性偏侧、姿势控制缺陷（本体感觉）、半球间协调受损（胼胝体）以及诸如轮替运动障碍等神经学软体征，这使我们推测运动功能存在普遍损害。
