Bhat Anjana N, Boulton Aaron J, Tulsky David S
Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA.
Autism Res. 2022 Jun;15(6):1156-1178. doi: 10.1002/aur.2711. Epub 2022 Mar 31.
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.
运动障碍在自闭症谱系障碍（ASD）儿童的整个童年和青少年时期普遍存在且持续存在。基于最近对5至15岁ASD儿童运动障碍的研究（即SPARK研究样本），该人群中87%-88%有运动障碍风险，这些问题一直持续到15岁，并与他们的核心（社交沟通技能和重复行为[RBs]）及共病（语言、认知和功能）障碍相关。持续到青少年期/成年期的运动障碍可能会对他们的独立日常生活技能、身体素质/活动水平以及身心健康产生负面影响。虽然多项研究探讨了ASD幼儿运动维度与核心/共病障碍之间的关系，但很少有研究探讨ASD学龄儿童/青少年中的此类关系。本文进行了一项进一步的多维度研究，以确定哪些运动领域（即大运动，包括视觉运动或多肢体协调/计划、精细运动[FM]或一般协调[GC]技能）最能区分ASD学龄儿童/青少年亚组，并有助于在考虑年龄和性别因素后预测核心和共病障碍。视觉运动、FM和某些GC技能在解释/预测社交沟通障碍的差异方面表现更好，而FM技能在解释/预测RB严重程度的差异方面略胜一筹。多肢体协调/计划和FM技能解释了/预测了认知延迟的差异，而视觉运动和FM技能解释了并更好地预测了语言延迟的差异。所有三个运动维度都解释了/预测了功能延迟的差异。本研究为将运动障碍纳入ASD定义（标准或说明符）提供了进一步的证据。通俗总结：大运动技能与ASD儿童的社交沟通和功能延迟有关（视觉运动技能与语言延迟有关，多肢体协调/计划技能与认知延迟有关）。精细运动技能与ASD中的重复行为严重程度、语言、认知和功能延迟有关。诊断人员应为有ASD风险和被诊断为ASD的儿童推荐系统的运动筛查、进一步评估和治疗。需要开展运动宣传并提高公众/临床社区的认识，以满足ASD儿童未得到满足的运动需求。
