HHS Public Access

Author manuscript
Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
Author Manuscript

Published in final edited form as:

Dev Med Child Neurol. 2024 January ; 66(1): 16–22. doi:10.1111/dmcn.15674.

Motor problems in autism: Co-occurrence or feature?

Haylie L. Miller1, Melissa K. Licari2, Anjana Bhat3, Lisa S. Aziz-Zadeh4,5, Tine Van Damme6,
Nicholas E. Fears7, Sharon A. Cermak8, Priscila M. Tamplain9
1School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
2Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
3Department of Physical Therapy, University of Delaware, Newark, DE, United States
Author Manuscript

4Department of Psychology, University of Southern California, Los Angeles, CA, United States
5Chan Division of Occupational Science & Occupational Therapy, University of Southern
California, Los Angeles, CA, USA
6Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
7School of Kinesiology, Louisiana State University, Baton Rouge, LA, United States
8Department of Pediatrics, Keck School of Medicine, University of Southern California, Los
Angeles, CA, United States
9Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
Author Manuscript

Abstract
Motor features of autism have long been acknowledged by clinicians, researchers, and community
stakeholders. Current DSM-5 and ICD-11 guidelines allow clinicians to assign a co-occurring
diagnosis of developmental [motor] coordination disorder (DCD) for autistic individuals with
significant motor problems. DCD is characterized by poor motor proficiency with an onset of
symptoms in early development. Studies have shown considerable overlap in the behavioral motor
features observed in autism and DCD. However, others indicate that motor problems in autism
and DCD may stem from different underlying sensorimotor mechanisms. Regardless of whether
autism has a unique motor phenotype or an overlap with DCD, changes need to be made in the
clinical pipeline to address motor problems in autism at the stages of recognition, assessment,
diagnosis, and intervention. Consensus is needed to address unmet needs in research on the
etiology of motor problems in autism and their overlap with DCD, to optimize clinical practice
Author Manuscript

guidelines. The development of screening and assessment tools for motor problems that are valid
and reliable for use with autistic individuals is essential, and an evidence-based clinical pipeline
for motor problems in autism is urgently needed.

Correspondence: Priscila M. Tamplain, Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Box
19407, Arlington, TX 76019-0407, USA. priscila.tamplain@uta.edu.
Author Note: In this manuscript, we use identity-first language to refer to autistic individuals, in alignment with current best-practice
recommendations encouraging avoidance of disorder-focused or medicalized language in discourse. A preference for identity-first
language in the developmental [motor] coordination disorder/dyspraxia community has not yet been documented, and so we continue
to use person-first language for this group. We use the current ICD-11/DSM-5 diagnostic terminology of ‘autism spectrum disorder’
and ‘developmental [motor] coordination disorder’ when referring to the diagnostic criteria or process. We recognize that identity is
deeply personal and affirm that all individual preferences regarding the language used to express identity are valid and should be
respected.
 Miller et al. Page 2

Many neurodevelopmental conditions are accompanied by motor problems that are

Author Manuscript

functionally relevant, but may not be assessed or prioritized in intervention planning. Several
recent studies have documented a high prevalence of clinically significant motor problems
in those with an autism spectrum disorder (ASD) diagnosis, ranging from 50% to 95%.1–4
These are present across many domains, including functional mobility, physical activity,
participation and competence in activities of daily living, and fall risk. Motor problems
present a significant barrier to the performance of daily living activities, as well as for social
and cognitive development.

The purpose of this review is to provide an overview of common motor features in autism
and discuss opportunities to improve identification and intervention for motor problems in
this population. At present, Internationa Classification of Diseases, 11th Edition (ICD-11)5
and DSM-56 guidelines permit clinicians to diagnose autistic individuals with co-occurring
Author Manuscript

developmental [motor] coordination disorder (DCD), a neurodevelopmental condition of

poor motor proficiency that affects activities of daily living. However, while it seems that
a high percentage of autistic individuals meet the clinical criteria for DCD,3 very few
actually receive a DCD diagnosis. Given that motor problems are a common and overlooked
feature of autism, they may be better recognized and addressed by adding a domain-specific
‘specifier’ to the ASD diagnostic criteria.1 Here, we provide an overview of the recent
literature and present a case for a more uniform structure to the assessment and treatment of
motor problems in autism.

MOTOR PROBLEMS IN AUTISM

There is strong empirical evidence that autistic individuals have differences in motor
behavior compared to neurotypical individuals. These can be separated into two categories:
Author Manuscript

motor stereotypies (e.g. hand flapping) and differences in motor control and motor
coordination (e.g. postural instability, hand–eye coordination). The scope of this discussion
is focused on motor control and motor coordination differences, not motor stereotypies, as
these are captured under DSM-5 diagnostic criteria and defined separately in the ICD-11
under 6A06. These motor differences persist in a variety of domains across the lifespan.
A recent systematic review demonstrated that infants later diagnosed with autism exhibit
significant motor differences,7 including delays in achieving motor milestones,8 and fine
and gross motor problems in infants at an elevated likelihood of being autistic between 6
months and 36 months.1,9 Studies have demonstrated the persistence of these differences
beyond childhood into adulthood, for example, in the domains of static and dynamic
balance10,11 and locomotion.12 Motor problems have also been highlighted when using
screening measures used to identify those at risk of coordination difficulties,2 broader
Author Manuscript

measures of adaptive functioning,1 and criterion-standard observational measures of motor

proficiency.3

Importantly, motor problems are as prevalent and functionally impactful as other domains
recognized as specifiers to an ASD diagnosis (e.g. intellectual and language impairment).1
For example, intellectual disability is a common specifier for ASD, and prevalence estimates
indicate approximately 30% to 50% of autistic individuals have an intellectual disability.

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 3

This rate is substantially lower than current prevalence estimates of motor problems in
autistic individuals on both parent-reported measures (87%)2 and observational measures
Author Manuscript

(97%; 85%).3,13 However, clinicians currently document motor problems in only around
1% of autistic individuals,1,3 highlighting a serious need for improved recognition and
documentation of motor problems in autism.

LIFESPAN FUNCTIONAL AND HEALTH CONSEQUENCES OF MOTOR

PROBLEMS IN AUTISM
Autistic individuals’ persistent motor problems have a lifelong impact on developmental
opportunities, and a downstream effect on daily living.1,14,15 Childhood consequences of
motor problems include limited access to object and environment exploration, difficulty
engaging with peers during play, and difficulty building non-verbal communication skills.
Motor delays in sitting and crawling16 and limited use of motor skills during social
Author Manuscript

interactions17 are among the earliest markers in children later diagnosed with ASD.
Further, a recent systematic review of 114 motor studies (total n > 6000) found that gross
motor performance in autistic children was strongly associated with social communication
performance, noting large effects for gross motor problems in autistic compared to
neurotypical children.18 Problems with locomotion, postural control, and manual dexterity
limit autistic children’s ability to comfortably engage in self-care behaviors including eating,
bathing, toileting, and dressing.19 Autistic adolescents’ and adults’ manual motor skills
correlate not only with concurrent daily living skills but also predict subsequent daily living
skills up to 8 years later.20 Autistic children and adults also experience barriers to physical
activity including perceived difficulty and motor challenges.21,22 However, little is known
about the long-term impact of decreased physical activity frequency and intensity across the
lifespan of autistic individuals, or the specific physical, environmental, and social barriers
Author Manuscript

they may encounter.23 There is an approximately 33% greater prevalence of overweight

and obese autistic adolescents compared to neurotypical adolescents,24 placing them at risk
for long-term health consequences. A recent longitudinal study tracking physical activity
of autistic individuals from age 9 to 18 years found that autistic children became more
physically inactive with age compared to neurotypical children.25 Given these findings, it is
clear that there is a critical need to identify and address motor problems in autism early, and
improve access to intervention and accommodation across the lifespan.

ASSESSMENT OF MOTOR PROBLEMS

Early recognition of motor problems is a prerequisite for early intervention and is vital in
the prevention of secondary adverse outcomes, such as physical inactivity and academic
Author Manuscript

difficulties. However, given the heterogeneous nature of motor problems in autistic children
and adolescents, a comprehensive assessment battery is necessary to capture potential
problems across different motor domains. Especially for autistic children, the administration
of such a comprehensive motor assessment can be challenging. Conversely, screening for
motor problems by means of a caregiver-reported questionnaire can optimize the cost–
benefit ratio and reduce the time and effort burden on all parties. Previous research indicates
that the Developmental Coordination Disorder Questionnaire, a 15-item caregiver-reported

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 4

questionnaire, can be used to detect motor problems in autistic children.26 Adding a brief
Author Manuscript

screening tool like the Developmental Coordination Disorder Questionnaire to standard

clinical procedures would provide clinicians with information about a child’s motor skills
that may not be observable during routine visits. This information can help guide decision-
making with regard to whether a full motor assessment is necessary.

For children with motor problems, comprehensive assessment may be needed to determine
the specific domains in which they require support or intervention. Several standardized
observational measures are available for this type of assessment, and may be appropriate for
use in autism. For example, the Movement Assessment Battery for Children (currently in its
second edition) has been used successfully to detect motor problems in autism.2,4,14,26 The
use of observational measures such as the Movement Assessment Battery for Children as
part of standard clinical practice of assessing autistic individuals’ motor skills can provide
clinically relevant information about their manual dexterity, eye–hand coordination, bilateral
Author Manuscript

coordination, and balance. Other movement assessments that have successfully been used
to characterize motor profiles in autism include the Bruininks-Oseretsky Test of Motor
Proficiency, Second Edition, Test of Gross Motor Development, Third Edition, and the
Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition. However,
there is a lack of assessments that last through adulthood, with the Bruininks-Oseretsky
Test of Motor Proficiency being the only one that can be used up to 21 years of age. It
is important to consider that some assessments are especially useful with a visual support
protocol, for example, the Test of Gross Motor Development.27 Depending on the specific
areas of motor problems an individual appears to experience, a combination of these
measures may be needed to sufficiently inform intervention and support planning. Further
research is needed to assess the validity and reliability of observational motor assessments in
autism across the lifespan.
Author Manuscript

Despite evidence for screening and assessment of motor problems in autistic individuals,
it has been suggested that motor delays and impairments are potentially explained by lack
of interest or motivation, difficulty managing social demands, or differences in intellectual
ability, among other factors. Discounting the fundamental nature of motor differences in
autism—independent of cognitive or social factors that may exacerbate their manifestation
in assessment contexts—does a disservice to the autistic community. It does not presume
intellectual and communicative competence and perpetuates ableist stereotypes that autistic
individuals only experience motor problems because they cannot understand instructions or
lack motivation to perform.28 Certainly, communication differences can present challenges
in any assessment setting. For that reason it is important for assessments to be done by
professionals who are experienced in working with autistic individuals, to ensure that the
Author Manuscript

observed motor behaviors are not better explained by other factors. But there is a large body
of evidence that autistic adolescents and adults have problems in motor domains that do
not involve instruction in daily living, such as standing balance and walking as described
previously. Further, many studies of autistic movement use assessment paradigms that have
been shown to be engaging and accessible for autistic individuals. Continued research on
the validity of standardized motor assessments in autism and clinical application of these
assessments is needed to raise awareness of the fundamental nature of motor problems in
autism, independent of cognitive and social skills.

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 5

IS IT CO-OCCURRING DCD?
Author Manuscript

Once motor problems are identified via appropriate assessments, clinicians are faced
with the challenge of assigning diagnostic codes or labels and making recommendations
for accommodations or interventions. Although a co-occurring diagnosis of DCD is
permitted by ICD-115 and DSM-5,6 questions remain about whether this is the best
approach. Unquestionably, there remains a need for further research to determine whether
motor problems in autism are distinct from those observed in other neurodevelopmental
conditions like DCD in their etiology, manifestation, and functional impact.29,30 In
the meantime, however, there is a human cost to taking a ‘wait and see’ approach
before addressing this issue in clinical practice. Autistic children, adolescents, and adults
experiencing motor problems may not have the information or documentation necessary to
access accommodative supports or intervention services. Since motor problems are not a
recognized feature of autism under the current guidelines, insurers and education systems
Author Manuscript

are often reluctant to provide coverage or resources unless a clinician also assigns a co-
occurring motor diagnosis (i.e. DCD).

Even though it can be helpful in circumstances where autistic people would otherwise not
have access to care for motor problems, assigning a DCD diagnosis is not a panacea in all
cases. There are three issues with a co-occurring diagnosis that may present barriers to care
for some autistic individuals. First, a diagnosis of DCD is not currently recommended until
at least 5 years of age,31 to account for natural variability that exists in the attainment of
motor skills. The problem with this age-related barrier is that a critical therapeutic window
to support the development of motor skills is likely to be missed. Second, if a diagnosis
of ASD is assigned before 5 years of age (as currently recommended), a later, secondary
diagnostic evaluation for DCD may place additional financial and time burden on families
Author Manuscript

and clinicians. Evaluation for DCD may be particularly difficult for families to access, or
not presented to them as an option, since DCD is under-recognized and underdiagnosed in
the general population32 and in autism.1,2 Third, some motor problems seen in autism are
distinct from features seen in individuals diagnosed with DCD, and so clinicians may be
hesitant to assign co-occurring DCD as a co-occurring diagnosis. This is perhaps the most
challenging issue, as there is limited research in this area on which to base a clinical practice
guideline or consensus.

An overview of the few studies that have compared autism to DCD have found that
problems with general motor ability as measured by the Movement Assessment Battery for
Children assessment are comparable between the two groups.3,13 However, for certain praxis
skills, such as imitation of meaningful actions and gesture to command, autistic children
Author Manuscript

perform significantly worse than children with DCD, and in the autism group only, imitation
errors correlate with emotion recognition ability.13 Thus, while general motor ability (i.e.
balance, manual dexterity, and aiming/catching) may be comparable between autism and
DCD, autism may be distinguished by poorer performance on imitation of meaningful
gestures and other praxis skills.

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 6

MOTOR IMPAIRMENT AS AN ASD SPECIFIER

Author Manuscript

Currently, there is a clear research-to-practice gap in the recognition and management

of motor problems in autism. Given that motor problems in autism are similar but not
always identical to those observed in DCD, resolving this gap is challenging. One possible
solution is to add ‘with or without accompanying motor impairment not otherwise explained
by motor stereotypies’ as a domain-specific specifier to the ASD diagnostic criteria. The
addition of a motor specifier would increase the likelihood that motor problems are assessed,
documented, and managed in concert with other autistic traits, similar to the current practice
for other domain-specific specifiers (i.e. language and intellectual impairments). Although
motor stereotypies are already captured under the restricted, repetitive behaviors domain
of the ASD diagnostic criteria, the full breadth of motor differences (e.g. motor control,
motor coordination) observed in autism are not well represented by the current taxonomy.
Affirming a motor specifier could serve as a triggering event for referral to comprehensive
Author Manuscript

motor assessment (e.g. by neurologists or physical/occupational therapists). It would also

enable autistic individuals to access motor-related services or accommodations, including
before the age of 5 years, before a co-occurring diagnosis of DCD could be considered.

Adding motor problems as an ASD specifier may, therefore, be an effective stop-gap

approach while research studies continue probing underlying etiology and diagnostic overlap
with DCD. If future studies determine that the etiology of motor problems in autism are
distinct from those observed in DCD, then a co-occurring diagnosis of DCD may not be
needed or appropriate in some cases. If future studies determine that the etiology of motor
problems in autism overlaps substantially with those observed in DCD, then the specifier
would still serve as a triggering event for assessment and a means of accessing early motor
intervention with less difficulty. It would, in essence, help to establish a clinical pipeline for
Author Manuscript

screening, evaluation, and management of motor problems and DCD in autism. Finally, but
certainly not of least importance, adding motor problems as a specifier would bring needed
attention to this issue in the clinical and caregiver community. Given that motor problems
are present in most autistic children in observational research studies but only diagnosed in
approximately 1% of autistic children in clinical practice, increased awareness is the first
step toward bridging the research-to-practice gap.

COMPLEX INTERRELATEDNESS BETWEEN MOTOR SKILLS AND OTHER

DOMAINS
Current evidence from large sample studies indicate that motor difficulties are present in
children with ASD with and without intellectual disability and they continue to predict
Author Manuscript

autistic traits and language and functional delays even after controlling for cognitive delays.
Therefore, while it is true that motor difficulties are greater in individuals with ASD and
intellectual disability, they continue to negatively impact communication and functioning
in the majority of autistic individuals, including autistic children without intellectual
disability.33

The complex interrelationships between IQ, language, sensory, and motor differences in
autism are evident in the dual task literature where the level of performance difference is

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 7

affected by task complexity.8,34,35 It is also evident in some studies relating motor skills
Author Manuscript

with IQ, language, and sensory skills. In preschool autistic children, IQ scores are positively
related with fine motor skills.36 Furthermore, social and communication functioning has
been found to be positively related to manual dexterity and fine motor skills in autistic
children and adolescents.37,38 While some studies have found that the relationship between
motor skills and daily living skills is mediated by IQ in adolescence,39 others have found
that sensory reactivity and motor skills uniquely contribute to daily living skills independent
of IQ in early childhood.14 Despite this literature, it remains unknown if the presence of
a greater number and magnitude of autistic traits exacerbates motor difficulties, or if early
motor difficulties negatively impact the developmental affordances required for acquisition
of cognitive, social communication, and other skills.40

Regardless of the outcome of this debate, motor differences have a clear and persistent
impact in autism. Motor differences are still evident even when there are not competing
Author Manuscript

cognitive, sensory, or language demands (e.g. quiet standing under normal visual and
proprioceptive conditions).41 Additionally, motor differences predict later development even
when controlling for IQ, language, and sensory domains. In a longitudinal study of 209
autistic children, autistic children’s gross motor skills at 2 years of age predicted subsequent
expressive and receptive language up to 9 years of age even when controlling for IQ and
autism symptoms.42 These findings indicate that there is likely variability in the effects
individual domains have on autistic individuals’ functional abilities. The challenge of teasing
out the relationships between these domains and their impact on functional abilities makes
it difficult to identify the mechanisms underlying motor problems in autistic individuals.
However, consideration needs to be given to understand these complex interactions to
enable more targeted interventions and accommodations for the specific needs of autistic
individuals.
Author Manuscript

AWARENESS AND ACCESS TO CARE

For decades, stakeholders in the autistic community have been calling for researchers and
clinicians to direct more attention toward issues that affect their physical health, mental
health, and well-being.43 Motor skills have known effects on each of these areas, and motor
skills interventions could provide significant improvements for autistic individuals’ quality
of life. The addition of motor impairment as a diagnostic specifier would not only elevate
community awareness of the presence and impact of motor problems in autism, but also
open new doors to physical therapy, occupational therapy, and other motor skill interventions
and accommodations.

Further, access to motor interventions and accommodations could provide autistic

Author Manuscript

individuals with opportunities to improve their physical and mental health. Physical health
improvements may be achieved through increased access to or comfort with physical
activity, decreased likelihood of falls or other injuries, and decreased risk of chronic
health conditions such as obesity. Mental health improvements may be achieved through
affirmation of lived experiences with motor problems and amelioration of frustration due to
lack of explanation for these problems, improved self-esteem, access to information about
accommodations and tools for self-advocacy in school or the workplace, and reduction of

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 8

the social isolation and limited participation commonly observed among individuals with
Author Manuscript

untreated motor problems.

There is precedent for modification to the ASD diagnostic criteria based on emerging
scientific evidence. In addition to the aforementioned specifiers for intellectual disability
and language skills, sensory difficulties were added to the diagnostic category of restricted
and repetitive behaviors. Yet, despite overwhelming evidence of its clinical relevance, motor
problems are still absent from the criteria. Gaps in motor development increase over time,
such that by 5 years of age, the motor skills of an autistic child are at the level of a child half
their age.44 Yet, access to motor-related services (e.g. occupational therapy/physical therapy)
decreases dramatically with age.45 This creates a clear unmet need that is not currently
addressed in clinical practice.

It is critical to increase awareness of motor problems in autism and establish a clear

Author Manuscript

pipeline for screening, assessment, and management. This pipeline should include a variety
of clinic- , school- , and community-based services, including both motor skills interventions
(e.g. occupational therapy/physical therapy) and adaptive recreation and fitness activities.
This pipeline must be accessible to individuals across the lifespan, so that those diagnosed
later in life do not fall through the cracks.

CONCLUSION
Regardless of whether autism has a unique motor phenotype or an overlap with DCD,
changes must be made in the clinical pipeline to address motor problems in autism
at the stages of recognition, assessment, diagnosis, and intervention/accommodation.
Collaboration between community stakeholders, researchers, and clinicians is urgently
needed to address this unmet need. We must continue research on the etiology of motor
Author Manuscript

problems in autism and their overlap with other clinical conditions like DCD, in order to
develop optimal clinical practice guidelines. What additional literature is needed to build
consensus on the significant and ubiquitous presentation of motor problems in autism, and to
prompt a change in current practices?

Autistic individuals deserve comprehensive care, including support for motor problems.
This will ensure that they have equitable opportunities to develop the motor skills needed
to engage comfortably and successfully in activities of daily living and recreation. Motor
problems may be the key to fully understanding functional differences in this population.
There is a vital need for services in this area across the lifespan, in order to adequately
support autistic individuals through changes in their developmental context (e.g. their
physical and cognitive states, social relationships, level of independence, and environments)
Author Manuscript

and the demands of their day-to-day activities.

ACKNOWLEDGMENTS
We are sincerely grateful to stakeholders in the autistic and DCD/dyspraxic communities for sharing their
experiences with motor problems in research studies and personal interactions–they are vital agents of change
with valuable expertise. We are also grateful to our partners in clinical practice, research, education, and advocacy
who are working tirelessly to address unmet needs.

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 9

Funding information
Author Manuscript

National Institute of Mental Health, Grant/Award Number: K01-MH107774

DATA AVAILABILITY STATEMENT

No data is provided for this manuscript.

Abbreviations:
ASD autism spectrum disorder

DCD developmental (motor) coordination disorder

REFERENCES
Author Manuscript

1. Licari MK, Alvares GA, Varcin K, et al. Prevalence of motor difficulties in autism spectrum
disorder: Analysis of a population-based cohort. Autism Res 2020; 13: 298–306. [PubMed:
31625694]
2. Bhat AN. Is motor impairment in autism spectrum disorder distinct from developmental
coordination disorder? A report from the SPARK study. Phys Ther 2020; 100: 633–44. [PubMed:
32154876]
3. Miller HL, Sherrod GM, Mauk JE, et al. Shared features or co-occurrence? Evaluating symptoms
of developmental coordination disorder in children and adolescents with autism spectrum disorder. J
Autism Dev Disord 2021; 51: 3443–55. [PubMed: 33387238]
4. Green D, Charman T, Pickles A, et al. Impairment in movement skills of children with autistic
spectrum disorders. Dev Med Child Neurol 2009; 51: 311–6. [PubMed: 19207298]
5. International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization
(WHO) 2019/2021 https://icd.who.int/browse11.
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th, ed.
American Psychiatric Publishing, 2013. DSM-V, 10.1176/appi.
Author Manuscript

7. Lim YH, Licari M, Spittle AJ, et al. Early motor function of children with autism spectrum disorder:
A systematic review. Pediatrics 2021; 147: e2020011270. [PubMed: 33510035]
8. Reynolds JE, Whitehouse AJO, Alvares GA, et al. Characterising the Early Presentation of Motor
Difficulties in Autistic Children. J Autism Dev Disord 2022; 52: 4739–49. [PubMed: 34739646]
9. Landa RJ, Gross AL, Stuart EA, Faherty A. Developmental trajectories in children with and without
autism spectrum disorders: the first 3 years. Child Dev 2013; 84: 429–42. [PubMed: 23110514]
10. Lim YH, Partridge K, Girdler S, Morris SL. Standing postural control in individuals with autism
spectrum disorder: systematic review and meta-analysis. J Autism Dev Disord 2017; 47: 2238–53.
[PubMed: 28508177]
11. Miller HL, Caçola PM, Sherrod GM, Patterson RM, Bugnariu NL. Children with autism spectrum
disorder, developmental coordination disorder, and typical development differ in characteristics of
dynamic postural control: a preliminary study. Gait Posture 2019; 67: 9–11. [PubMed: 30245240]
12. Eggleston JD, Harry JR, Hickman RA, Dufek JS. Analysis of gait symmetry during over-ground
walking in children with autism spectrum disorder. Gait Posture 2017; 55: 162–6. [PubMed:
Author Manuscript

28458147]
13. Kilroy E, Ring P, Hossain A, et al. Motor performance, praxis, and social skills in autism spectrum
disorder and developmental coordination disorder. Autism Res 2022; 15: 1649–64. [PubMed:
35785418]
14. Jasmin E, Couture M, McKinley P, et al. Sensori-motor and daily living skills of preschool children
with autism spectrum disorder. J Autism Dev Disord 2009; 39: 231–41. [PubMed: 18629623]
15. Fears NE, Palmer SA, Miller HL. Motor skills predict adaptive behavior in autistic children and
adolescents. Autism Res 2022; 15: 1083–9. [PubMed: 35322578]

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 10

16. LeBarton ES, Iverson JM. Associations between gross motor and communicative development in
at-risk infants. Infant Behav Dev 2016; 44: 59–67. [PubMed: 27314943]
Author Manuscript

17. Srinivasan SM, Bhat AN. Differences in object sharing between infants at risk for autism and
typically developing infants from 9 to 15 months of age. Infant Behav Dev 2016; 42: 128–41.
[PubMed: 26803417]
18. Wang LA, Petrulla V, Zampella CJ, Waller R, Schultz RT. Gross motor impairment and its relation
to social skills in autism spectrum disorder: A systematic review and two meta-analyses. Psychol
Bull 2022; 148: 273–300. [PubMed: 35511567]
19. Travers BG, Lee L, Klans N, et al. Associations among daily living skills, motor, and sensory
difficulties in autistic and nonautistic children. Am J Occup Ther 2022; 76: 7602205020.
[PubMed: 35171982]
20. Travers BG, Bigler ED, Duffield TC, et al. Longitudinal development of manual motor ability in
autism spectrum disorder from childhood to mid-adulthood relates to adaptive daily living skills.
Dev Sci 2017; 20: e12401.
21. Nichols C, Block ME, Bishop JC, McIntire B. Physical activity in young adults with autism
spectrum disorder: Parental perceptions of barriers and facilitators. Autism 2019; 23: 1398–407.
Author Manuscript

[PubMed: 30486668]
22. Buchanan AM, Miedema B, Frey GC. Parents’ perspectives of physical activity in their adult
children with autism spectrum disorder: A social-ecological approach. Adapt Phys Activ Q 2017;
34: 401–20. [PubMed: 28985096]
23. Jones RA, Downing K, Rinehart NJ, et al. Physical activity, sedentary behavior and their correlates
in children with autism spectrum disorder: A systematic review. PloS One 2017; 12: e0172482.
[PubMed: 28245224]
24. Hill AP, Zuckerman KE, Fombonne E. Obesity and autism. Pediatrics. 2015; 136: 1051–61.
[PubMed: 26527551]
25. Dahlgren J, Healy S, MacDonald M, et al. Physical activity and screen time among youth with
autism: A longitudinal analysis from 9 to 18 years. Autism 2021 May; 25: 1090–9. [PubMed:
33406885]
26. Van Damme T, Vancampfort D, Thoen A, Sanchez CP, Van Biesen D. Evaluation of the
developmental coordination questionnaire (DCDQ) as a screening instrument for co-occurring
motor problems in children with Autism Spectrum Disorder. J Autism Dev Disord 2022; 52:
Author Manuscript

4079–88. [PubMed: 34535846]

27. Allen KA, Bredero B, Van Damme T, Ulrich DA, Simons J. Test of Gross Motor Development-3
(TGMD-3) with the use of visual supports for children with autism spectrum disorder: Validity and
reliability. J Autism Dev Disord 2017; 47: 813–33. [PubMed: 28091840]
28. Brownlow C, Lawson W, Pillay Y, Mahony J, Abawi D. “Just ask me”: The importance of
respectful relationships within schools. Front Psychol 2021; 12: 678264. [PubMed: 34211427]
29. Kilroy E, Cermak SA, Aziz-Zadeh L. A Review of functional and structural neurobiology of the
action observation network in autism spectrum disorder and developmental coordination disorder.
Brain Sci 2019; 9: 75. [PubMed: 30925819]
30. Caçola P, Miller HL, Ossom Williamson P. Behavioral comparisons in autism spectrum disorder
and developmental coordination disorder: a systematic literature review. Res Autism Spectr Disord
2017; 38: 6–18. [PubMed: 29057009]
31. Blank R, Barnett AL, Cairney J, et al. International clinical practice recommendations on
the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental
Author Manuscript

coordination disorder. Dev Med Child Neurol 2019; 61: 242–85. [PubMed: 30671947]
32. Delgado-Lobete L, Santos-del-Riego S, Pértega-Díaz S, Montes-Montes R. Prevalence of
suspected developmental coordination disorder and associated factors in Spanish classrooms. Res
Dev Disabil 2019; 86: 31–40. [PubMed: 30654220]
33. Bhat A. Multidimensional motor performance in children with autism mostly remains stable with
age and predicts social communication delay, language delay, functional delay, and repetitive
behavior severity after accounting for intellectual disability: A SPARK dataset analysis. Autism
Res 2023; 16: 208–29. [PubMed: 36533674]

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 11

34. Bucci MP, Doyen C, Contenjean Y, Kaye K. The effect of performing a dual task on postural
control in children with autism. IRSN Neurosci 2013; 796174.
Author Manuscript

35. Carment L, Khoury E, Dupin L, et al. Common vs. distinct visuomotor control deficits in autism
spectrum disorder and schizophrenia. Autism Res 2020; 13: 885–96. [PubMed: 32157824]
36. Yu T, Chou W, Chow JC, Lin C, Tung L, Chen K. IQ discrepancy differentiates levels of fine motor
skills and their relationship in children with autism spectrum disorders. Neuropsychiatr Dis Treat
2018; 14: 597–605. [PubMed: 29503543]
37. MacDonald M, Lord C, Ulrich DA. The relationship of motor skills and social communicative
skills in school-aged children with autism spectrum disorder. Adapt Phys Activ Q 2013; 30: 271–
82. [PubMed: 23860508]
38. Craig F, Crippa A, Ruggiero M, et al. Characterization of Autism Spectrum Disorder (ASD)
subtypes based on the relationship between motor skills and social communication abilities.
Human Mov Sci 2021; 77: 102802. [PubMed: 33894651]
39. Green D, Charman T, Pickles A, et al. Impairment in movement skills of children with autistic
spectrum disorders. Dev Med Child Neurol 2009; 51: 311–6. [PubMed: 19207298]
40. Little LM, Ausderau K, Sideris J., Baranek GT. Activity participation and sensory features among
Author Manuscript

children with autism spectrum disorders. J Autism Dev Disord 2015; 45: 2981–90. [PubMed:
25975628]
41. Minshew NJ, Sung K, Jones BL, Furman JM. Underdevelopment of the postural control system in
autism. Neurol 2004; 63: 2056–61.
42. Bedford R, Pickles A, Lord C. Early gross motor skills predict the subsequent development of
language in children with autism spectrum disorder. Autism Res 2015; 9: 993–1001. [PubMed:
26692550]
43. Roche L, Adams D, Clark M. Research priorities of the autism community: A systematic review of
key stakeholder perspectives. Autism 2021; 25: 336–48. [PubMed: 33143455]
44. Lloyd M, MacDonald M, Lord C. Motor skills of toddlers with autism spectrum disorders. Autism
2013; 17: 133–46. [PubMed: 21610184]
45. Srinivasan S, Ekbladh A, Freedman B, Bhat A. Needs assessment in unmet healthcare and family
support services: A survey of caregivers of children and youth with autism spectrum disorder in
Delaware. Autism Res 2021; 14: 1736–58. [PubMed: 33876563]
Author Manuscript
Author Manuscript

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.
 Miller et al. Page 12

What this paper adds

Author Manuscript

• Motor problems in autism are highly prevalent, yet underdiagnosed and

poorly managed.

• An evidence-based clinical pipeline for motor problems in autism is urgently

needed.
Author Manuscript
Author Manuscript
Author Manuscript

Dev Med Child Neurol. Author manuscript; available in PMC 2024 February 16.