Motor Skill Intervention in Autism: A Neglected Component

Autism spectrum disorder (ASD) is a developmental disorder of varying severity that is defined by challenges in social interaction and communication along with repetitive thought and behaviour patterns. It is evident from early childhood. ¹ Young children with ASD consistently exhibit gross and fine motor deficits, with or without abnormal movement patterns. Numerous studies have investigated a wide range of questions regarding the motor skills of older children with ASD. The prevalence of motor difficulties in autism has been widely investigated over the years. Ming et al. ² found 51% of children on the spectrum had hypotonia, which improved over time. However, Lloyd et al., ³ who investigated motor delays in young children on the spectrum, found that these delays increased over time. More recently, Hilton et al. ⁴ estimated that around 83% of children with autism had motor skill deficits. The deficits can manifest in different ways—difficulties in balance and coordination, poor motor planning, postural instability, and odd gait patterns.

Motor skills have been linked to different aspects of development in ASD. The delays in motor skills have a snowball effect across all developmental domains. ⁵ Fine motor and gross motor skills have been found to affect adaptive behaviour among young children on the autism spectrum. It is also related to calibrated autism severity scores; children with poorer motor skills had higher calibrated autism scores. ⁶ One systematic review of the literature found motor skills related to social skills. ⁷ Belmonte et al., ⁸ in their study at an early intervention clinic, found that motor-impaired children learned language more slowly than those who did not have motor impairments. They have emphasized the need for assessing and incorporating motor skill intervention into early intervention programs as they found motor difficulties could range from pointing to articulation. It is heartening to see that an increasing number of multidisciplinary centres that have physiotherapists in their teams and were hitherto catering primarily to other developmental disabilities are now offering their services to children with autism as well. Among autism intervention models, the indigenously developed Communication DEALL early intervention program is one of the few to consciously incorporate motor skill training as one of its crucial components. ⁹

While this impact of motor development on ASD is reflected in research, it is not a typically stated family concern. Arguably, it is an oft-neglected area of intervention, as the primary focus of most intervention programs remains communication and behaviour. Ming et al. ² have rightly pointed out that children with ASD, unless they have a considerable gross motor delay, are likely to miss out on motor skill intervention as most intervention programs do not account for it. Physiotherapists trained to work with motor skills are rarely a part of the rehabilitation team of autism early interventionists.

Along with adopting a transdisciplinary approach to intervention, it will be worthwhile for the entire team to gain some knowledge of the other team members’ goals and methods. This will ensure a more holistic approach to meeting the child’s interventional needs rather than each team member working in isolation.

While there is limited research on physiotherapy approaches in autism, children on the spectrum will benefit from physiotherapy that addresses hypotonia, balance, coordination, motor planning, and fine motor skills.

Physiotherapists have an in-depth knowledge and skill set to teach these skills and modulate sensory-motor difficulties in children. However, most Indian universities at the undergraduate level have a single chapter on autism. There is no theoretical exposure at the postgraduate level. Therefore, the lacunae in a physiotherapist’s knowledge of ASD must be addressed at the educational, training, and research levels. Continued Medical Education (CME) programs focusing on autism can be conducted for qualified paediatric physiotherapists. If this need is addressed, the more significant implications of a physiotherapist being a part of the core team of interventionists will have far-reaching results. A growing number of physiotherapists must be exposed to and trained on the vast array of motor deficits in autism spectrum disorders. To have this sufficient evidence-based practice, more research projects are necessary in the area of motor skill intervention in ASD.