My ASD Child: Motor Skills Disorder in Kids with ASD Level 1 [High-Functioning Autism]

"Is it common for children on the autism spectrum to be rather clumsy and to have problems with motor skills? If so, how can it be diagnosed/treated?"

Neurological in origin, Motor Skills Disorder (MSD) is a developmental disorder that impairs motor coordination in daily activities. Many kids with ASD or High-Functioning Autism (HFA) experience deficits in motor skills development, which often manifest as abnormal clumsiness (although it may not be major enough to be considered a disorder in and of itself).

MSD is a result of weak or disorganized connections in the brain, which then translates to trouble with motor coordination. Movements are performed because the brain sends messages to the area requiring action. MSD is a result of weak or poorly structured neural pathways to the moving parts of the body.

Clumsiness is a matter of poor balance and gross motor coordination. The origin of this deficit is the vestibular system of the inner ear. The vestibule is an organ responsible for maintaining balance and coordination and is located beside the cochlea, which acts as a sound receptor. Although they attend to different information, the proximity of the vestibule and cochlea allows them to work together. But, if one system is not functioning well, the other is concurrently affected.

ASD children with MSD tend to have an overly sensitive tactile system that causes them to perceive the most gentle touch as objectionable. They may also have a very low pain-threshold or an automatic reaction of fear when touched (i.e., “tactile defensiveness”). This is a result of a sensory processing disorder, which is a problem in the way the child’s brain interprets information received from the senses. This issue (similar to that of coordination) originates in the vestibule, because all sensory information is transmitted to the vestibule before being sent to the cerebellum (i.e., the part of the brain associated with movement).

Kids with MSD often suffer with low self-esteem resulting from poor ability to play sports and teasing by their peers. The disorder can be extremely disabling both at school and in everyday life due to impairment of functioning. Young people with this disorder are also at risk for obesity due to the higher rates of physical inactivity.

Kids with MSD have a variety of symptoms depending on the age of diagnosis. Infants may present with non-specific findings, such as floppy baby (i.e., hypotonia) or rigid baby (i.e., hypertonia), and may be delayed in their ability to sit, stand or walk. Toddlers may have difficulty feeding themselves. Older kids may have a hard time learning to hold a pencil, throw and catch a ball, ride a bike, place a drinking glass on the table without spilling the contents, etc.

As children with this disorder age, they often avoid physical activities, especially those requiring complex motor behaviors (e.g., sports, dancing, drawing, gymnastics, swimming, cycling, etc.). This is due to the child’s propensity to fall or trip more often than others and their inability to complete motor tasks adequately. These children may have more bruises or superficial skin injuries due to being "clumsy." They may often feel unable to judge spatial distances, have difficulty with shutting off faucets, turning off devices, and tend to have trouble putting together puzzles or toys.

Diagnosis—

If you suspect that your youngster may suffer from MSD, consult with your doctor. The first step in diagnosis is conducting a complete physical, neurological, and motor exam in order to determine that other movement or neuromuscular disorders are not causing the problems. During this exam, the doctor will ask you about various major developmental milestones to try to understand just how "lagging" your youngster's development may be. The doctor may refer you to a child neuropsychologist for more extensive assessment with some of the following tools:

The Bender Gestalt Test is used to assess visual-motor integration and visual perception skills (e.g., whether the eyes and the parts of the brain related to vision communicate with each other appropriately). This test consists of nine figures that the youngster must copy.
The Bruininks-Oseretsky Test of Motor Proficiency assesses the fine and gross motor skills of kids ages 4 to 14. These tasks often appeal to kids because they are similar to typical childhood activities (e.g., throwing and catching a ball, running, doing pushups, etc.). This test is the most widely used assessment of motor ability, and can be used on a wide range of young people, from able-bodied children to those with severe physical handicaps.
Reitan-Indiana Neuropsychological Test Battery for Children, an assessment for kids ages 5-8 years, provides a measure of overall functioning and hones in on specific motor skills or impairments that may be present. A corresponding test for older kids (ages 9-14), the Halstead Neuropsychological Test Battery for Children, is also available.

Treatment—

Physical or occupational therapists can work with young people affected by MSD to develop and improve their physical skills and strengthen their muscles. Community-based services in the home or school-setting may also be beneficial. Also, "by-pass methods" can be used (i.e., special adaptations such as allowing an unlimited amount of time for HFA kids to take tests, providing modifications in requirements for handwriting, using specialty tools such as left-handed scissors, adaptive writing instruments that help these kids to achieve academic and occupational goals, etc.).

Targeted multi-sensory interventions include Sensory Integrative Therapy and Perceptual Motor Training:

Sensory Integrative Therapy teaches children how to properly absorb and sort information about sensory experiences (e.g., touch, body position, sound, how hard to bite down, how wide to open your mouth, etc.).
Perceptual Motor Training involves retraining the child's body to recognize and prioritize various sources of stimuli and respond accordingly (e.g., they may learn how to use certain muscle groups rather than others while walking or grasping things).

The course of MSD is unpredictable. For some autistic kids, the disorder essentially goes away after a while. For others, the lack of coordination continues through the teenage years and into young adulthood. Though early intervention is better than later intervention, treatment received as a grown-up can still help lessen the severity of symptoms.

Resources for parents of children and teens on the autism spectrum: