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Behavioral comparisons in Autism Spectrum Disorder and Developmental Coordination Disorder: A systematic literature review
Abstract
Background:
Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) are developmental disorders that, since the DSM-5, can be diagnosed as co-occurring conditions. While some recent studies suggest that ASD and DCD have similar traits, others show clear behavioral distinctions between the two conditions. By gathering all studies that included (1) an ASD group and a DCD group, (2) an ASD+DCD group and a DCD group, or (3) ASD, ASD+DCD, and DCD groups, we aimed to identify similarities and differences in behaviors between the two disorders.
Method:
We used a systematic search of PubMed (1946 -), Scopus (1970 -), PsycINFO (via EBSCO, 1600 -), CINAHL (via EBSCO, 1937 -), SportDiscus (via EBSCO, 1985 -), and WorldCat (via FirstSearch) in addition to reference list and author name searching PubMed, Scopus, PsycINFO, CINAHL, SportDiscus, and WorldCat to identify original studies that met the following criteria: (1) an ASD group and a DCD group, (2) an ASD+DCD group and a DCD group, or (3) ASD, ASD+DCD, and DCD groups.
Results:
From the 1,598 articles screened, 11 were included in the qualitative analysis. The articles included reported more differences than similarities in individuals with ASD and DCD, with clear distinctions for working memory ability, gestural performance, grip selection, and cortical thickness. Only two studies reported similarities in face processing abilities and perceived competence, and the interventional studies showed group similarities in behavior improvement, such as intelligence and attention.
Conclusions:
Based on the articles reviewed, we conclude that while DCD and ASD share some behavioral symptoms, the symptom profiles of each disorder are unique and separable. We recommend that the evaluation of potential DCD in individuals with ASD be performed systematically and thoroughly, so as to distinguish this co-occurring condition from sensorimotor symptoms associated with ASD.
... Sometimes, we observe that fine motor coordination can also be affected (21,174,175). Several authors have noted both differences and similarities between ASD and DCD. ...
... These authors observed that based on symptom severity, children with ASD who were measured to be "more able" did not diverge on any measured skills from DCD children, in contradistinction to children classified as "less able." The authors wondered whether DCD and ASD vary more in the range of symptom severity than in a singular behavioral domain (174). ...
... The greatest similarity between ASD and DCD in Sumner and colleagues' review was a paucity of significant effects of cognitive intervention. Concerning treatment, no significant improvement effects were noted in both DCD and ASD groups of individuals (174) or in IQ (188). The ability to train and improve in various domains, especially cognitive, is similar for both conditions. ...
We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to developmental asynchrony and unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in ASD.
... To the best of our knowledge, only six other prior studies (Dewey et al., 2007;Green et al., 2002;Miller et al., 2021;Paquet et al., 2019;Sumner et al., 2016;Wisdom et al., 2007) and a systematic review (Caçola et al., 2017) have directly compared motor and/or praxis skills between individuals with ASD and DCD. Taken together, these studies indicate that in praxis skills, children with ASD perform worse than children with DCD (Dewey et al.; Green et al.; Paquet et al.), however none of these studies have controlled for social skills in their comparisons. ...
... We note that given the MABC-2 was used as an inclusion criterion of the DCD group and not the ASD group, we refrain from drawing many conclusions from those between group comparisons, especially when comparing MABC-2 total scores. Nevertheless, in line with our hypothesis and consistent with the existing research (Caçola et al., 2017), both groups showed poor performance on all MABC-2 total scores and subsections (balance, catching and aiming, manual dexterity) with no significant differences between the groups. Further, we hypothesized that, compared to the TD and DCD groups, the ASD group would have more severe impairments on praxis measures, which may be considered more social in nature than motor performance scores from the MABC-2. ...
... These findings have strong implications for screening and diagnosis of ASD and DCD and may have a translational impact on motor, imitation-based, and social skills interventions for each group/subgroup. Further research is needed to determine whether motor coordination and praxis deficits should be considered a cardinal feature of ASD as suggested by Fournier et al. (2010) or whether DCD and ASD are distinct but highly comorbid disorders as posited by Caçola et al. (2017). ...
Previous research has shown that individuals with autism spectrum disorder (ASD) and developmental coordination disorder (DCD) may have overlapping social and motor skill impairments. This study compares ASD, DCD, and typically developing (TD) youth on a range of social, praxis and motor skills, and investigates the relationship between these skills in each group. Data were collected on participants aged 8–17 (n = 33 ASD, n = 28 DCD, n = 35 TD). Overall, the clinical groups showed some similar patterns of social and motor impairments but diverged in praxis impairments, cognitive empathy, and Theory of Mind ability. When controlling for both social and motor performance impairments, the ASD group showed significantly lower accuracy on imitation of meaningful gestures and gesture to command, indicating a prominent deficit in these praxis skills in ASD. Individuals with autism spectrum disorder (ASD) and developmental coordination disorder (DCD) have social and motor skill impairments to varying degrees. This study compares ASD, DCD, and typically developing (TD) youth on a range of social, praxis, and motor skills. ASD and DCD shared similar patterns of gross and fine motor skills, but differed in skills related to making gestures. Specifically, our results also suggest that ASD has a prominent deficit in gesture performance and meaningful imitation compared to TD and DCD groups.
... Recent literature has attempted to shed light on whether ASD and DCD are distinct disorders that simply co-occur in some children or whether motor impairment is truly a defining feature of ASD. 32,[53][54]55 Some have argued that DCD symptoms in a child with developmental issues may be suggestive of a general brain dysfunction; hence, it is not specific to Motor Impairment in ASD 18 ASD. 56 A recent systematic review highlighted multiple behavioral similarities and differences between children with ASD and DCD and concluded that motor impairments tend to be similar across the two groups, with children with high-functioning ASD and those with DCD performing at similar levels. ...
... 56 A recent systematic review highlighted multiple behavioral similarities and differences between children with ASD and DCD and concluded that motor impairments tend to be similar across the two groups, with children with high-functioning ASD and those with DCD performing at similar levels. 32 Furthermore, ASD is a more complex multisystem disorder wherein some children with ASD may have greater symptom severity that extends across motor, social communication, and cognitive/behavioral systems compared to children with DCD. 32 A lone neuroimaging study comparing motor performance and functional connectivity between children with ASD+DCD, ASD only, DCD only, and TD controls revealed that while the level and nature of motor impairment was fairly similar between children with ASD+DCD compared to children with DCD only; there was little overlap in the connectivity abnormalities observed across the two groups. ...
... 32 Furthermore, ASD is a more complex multisystem disorder wherein some children with ASD may have greater symptom severity that extends across motor, social communication, and cognitive/behavioral systems compared to children with DCD. 32 A lone neuroimaging study comparing motor performance and functional connectivity between children with ASD+DCD, ASD only, DCD only, and TD controls revealed that while the level and nature of motor impairment was fairly similar between children with ASD+DCD compared to children with DCD only; there was little overlap in the connectivity abnormalities observed across the two groups. 54 In fact, connectivity patterns of children with "DCD only" were least abnormal and closest to that of TD controls whereas children with ASD or ASD+DCD showed ASD-specific excessive short-range connectivity which was not seen in children with DCD. ...
Eighty‐seven percent of a large sample of children with autism spectrum disorder (ASD) are at risk for motor impairment (Bhat, Physical Therapy, 2020, 100, 633–644). In spite of the high prevalence for motor impairment in children with ASD, it is not considered among the diagnostic criteria or specifiers within DSM‐V. In this article, we analyzed the SPARK study dataset (n = 13,887) to examine associations between risk for motor impairment using the Developmental Coordination Disorder‐Questionnaire (DCD‐Q), social communication impairment using the Social Communication Questionnaire (SCQ), repetitive behavior severity using the Repetitive Behaviors Scale – Revised (RBS‐R), and parent‐reported categories of cognitive, functional, and language impairments. Upon including children with ASD with cognitive impairments, 88.2% of the SPARK sample was at risk for motor impairment. The relative risk ratio for motor impairment in children with ASD was 22.2 times greater compared to the general population and that risk further increased up to 6.2 with increasing social communication (5.7), functional (6.2), cognitive (3.8), and language (1.6) impairments as well as repetitive behavior severity (5.0). Additionally, the magnitude of risk for motor impairment (fine‐ and gross‐motor) increased with increasing severity of all impairment types with medium to large effects. These findings highlight the multisystem nature of ASD, the need to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD, and the need for appropriate motor screening and assessment of children with ASD. Interventions must address not only the social communication and cognitive/behavioral challenges of children with ASD but also their motor function and participation.
Lay Abstract
Eighty‐eight percent of the SPARK sample of children with ASD were at risk for motor impairment. The relative risk for motor impairment was 22.2 times greater in children with ASD compared to the general population and the risk increased with more social communication, repetitive behavior, cognitive, and functional impairment. It is important to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD and there is a need to administer appropriate motor screening, assessment, and interventions in children with ASD.
... Study quality was independently assessed by two reviewers using the criteria proposed by Caçola, Miller, & Williamson (Caçola, Miller, & Williamson, 2017). These criteria included seven questions regarding the appropriate inclusion and description of participants, appropriate outcome measures, appropriate statistical analyses, consideration of confounding factors, and a discussion of implications and limitations of the findings. ...
... These seven criteria were answered with a 'yes' or 'no' and any disagreements between reviewers about the assessment of study quality were resolved through discussion. The quality of an article was perceived as poor when four or more questions were answered with a 'no', as average when three questions were answered with a 'no' and as high when two or less articles were answered with a 'no' (Caçola et al., 2017). The quality of the included studies was taken into account in the narrative synthesis of the findings. ...
... The following criteria were proposed byCaçola, Miller, & Williamson (Caçola et al., 2017). a Was there a clear description of participants regarding age and sex? b Was the diagnosis made by a pediatrician or according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)? ...
The aim of this review was to examine what is presently known about the nature of motor coordination and control problems in children with developmental coordination disorder (DCD) during ball catching and to provide directions for future research. A systematic literature search was conducted using four electronic databases (PubMed, Embase, PsycINFO and Web of Science), which identified 15 eligible studies. The results of the included studies were discussed, structured around the target population characteristics, the task used to measure motor coordination and control aspects, and the type of outcome. Children with DCD experience difficulties with both motor coordination and control during ball catching. They have been suggested to apply four compensation strategies to overcome these difficulties: a later initiation of the reaching phase, an earlier initiation of the grasping phase, a higher degree of coupling of the joints both intra-and inter-limb, and fixating the joints. However, despite these compensation strategies, children with DCD still caught fewer balls than typically developing children in all studies. This was especially due to a higher amount of grasping errors, which indicates a problem with the timing of the grasping phase. Directions for future research and practical implications were discussed.
... 31 Recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria specifically allow children to hold a dual diagnosis of ASD and DCD. 4 However, given the complex, multisystem presentation of ASD, it is difficult for clinicians (ie, pediatricians, clinical psychologists, and developmental neurologists who diagnose ASD or pediatric physical or occupational therapists who treat motor problems) to differentiate whether the motor comorbidities impact daily functioning above and beyond the core impairments associated with ASD. 32 Additionally, if motor impairments are already pervasive in the ASD population, it is difficult to determine the level of motor impairment that warrants a dual diagnosis of DCD. Ultimately, the under-recognized nature of motor impairments in ASD makes it difficult for children and families to access occupational therapy (OT)/physical therapy services. ...
... 32 ,54-56 Some have argued that DCD symptoms in a child with developmental issues may be suggestive of a general brain dysfunction; hence, it is not specific to ASD. 57 A recent systematic review highlighted multiple behavioral similarities and differences between children with ASD and DCD and concluded that motor impairments tend to be similar across the 2 groups, with children with high-functioning ASD and those with DCD performing at similar levels. 32 Furthermore, ASD is a more complex multisystem disorder wherein some children with ASD may have greater symptom severity that extends across motor, social communication, and cognitive/behavioral systems compared with children with DCD. 32 A lone neuroimaging study comparing motor performance and functional connectivity between children with ASD + DCD, ASD only, DCD only, and typically developing (TD) controls revealed that although the level and nature of motor impairment were fairly similar between children with ASD + DCD compared with children with DCD only, there was little overlap in the connectivity abnormalities observed across the 2 groups. ...
... 32 Furthermore, ASD is a more complex multisystem disorder wherein some children with ASD may have greater symptom severity that extends across motor, social communication, and cognitive/behavioral systems compared with children with DCD. 32 A lone neuroimaging study comparing motor performance and functional connectivity between children with ASD + DCD, ASD only, DCD only, and typically developing (TD) controls revealed that although the level and nature of motor impairment were fairly similar between children with ASD + DCD compared with children with DCD only, there was little overlap in the connectivity abnormalities observed across the 2 groups. 54 In fact, connectivity patterns of children with "DCD only" were least abnormal and closest to those of TD controls, whereas children with ASD or ASD + DCD showed ASD-specific excessive short-range connectivity, which was not seen in children with DCD. ...
Background:
Motor impairments are pervasive in Autism Spectrum Disorder (ASD) however, children with ASD rarely receive a dual diagnosis of Developmental Coordination Disorder (DCD). The Simons Foundation SPARK study engaged families affected by ASD through an online study.
Objectives:
The DCD parent questionnaire (DCDQ) was used to assess the prevalence of a risk for motor impairment or DCD in children with ASD between 5 and 15 years of age.
Design:
This paper utilizes parent reports from a large database of children with ASD.
Methods:
A total of 16,705 parents of children with ASD completed the DCDQ. We obtained our final SPARK dataset (n = 11,814) after filtering the invalid data, using stronger cut-offs to confirm ASD traits, and excluding children with general neuromotor impairments/intellectual delays. We compared DCDQ total and subscale scores from the SPARK dataset to published norms for each age between 5 and 15 years.
Results:
Proportion of children with ASD at-risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services.
Limitations:
Our analysis of a large database of parent-reported outcomes using the DCDQ did not involve follow-up clinical assessments.
Conclusions:
Using a large sample of children with ASD, we show that a risk for motor impairment or DCD was present in the majority of children with ASD and persists into adolescence; yet, only a small proportion of children with ASD were receiving physical therapy interventions. A diagnosis of ASD must trigger motor screening and evaluations and appropriate interventions by physical and occupational therapists to address the functional impairments of children with ASD while also positively impacting their social communication, cognition, and behavior. Using valid motor measures, future research must determine if motor impairment is a fundamental feature of ASD.
... Robust meta-analysis has revealed that motor deficits are a potential core symptom of ASD [4], and the prevalence of motor deficits in ASD is well-known. Children with ASD and developmental coordination disorder (DCD) generally overlapped [5][6][7]. ...
... The European Academy for Childhood Disability recommended using DCDQ for criteria B of DCD [36]. An overlap between ASD and DCD is observed in children [5,7]. We estimated that children with ASD might have DCD, although they could not be determined retrospectively. ...
Background
An individual with autism spectrum disorder (ASD) has social skill, motor skill, and motion perception deficits. However, the relationship among them was not clarified. Therefore, this study aimed to evaluate the effects of motor skills on social skills and motion perception.
Methods
Five typically developed children and fourteen children with ASD participated in our study. The N200 component, a brain activity indicating motion perception, was induced in mid-temporal (MT/V5) brain area by watching a random dot kinematograph, and was recorded using a scalp electroencephalogram. Furthermore, the social responsiveness scale (SRS) indicating the social skill deficit, the developmental coordination disorder questionnaire (DCDQ) estimating the developmental coordination disorder (DCD), and the movement assessment battery for children second edition (MABC-2) indicating motor skills were recorded in the children with ASD. A hierarchical multiple regression analysis was conducted to examine the modulation effects of motor skills on the relationship between social skills and motion perception. The dependent variable was the N200 latency, and the independent variables were SRS, MABC-2, and combined MABC-2 and SRS.
Results
The N200 latency was more delayed in children with ASD relative that in typically developed children. Intact balance ability modulated the relationship between social skills and N200 latency in children with ASD. Within the high balance ability, when the social skills worsened, the N200 latency was shortened.
Conclusions
This is the first report that intact motor skills could modulate the relationship between social skills and motion perception.
... Another common co-occurrence is Autism Spectrum Disorder (ASD; Caçola et al., 2017). ASD can be diagnosed as a co-occurring disorder of DCD since the DSM-5, and researchers are just beginning to explore the co-occurring diagnosis. ...
... Unlike ADHD, existing literature clearly supports that the difficulties sourcing from DCD or ASD are unique (Paquet et al., 2019). For example, a systematic review of DCD and ASD behavio ral outcomes primarily found clear differences between DCD and ASD (Caçola et al., 2017). Thus, it can be assumed that co-occurring cases of DCD and ASD present a much more complex symptom profile than DCD or ASD alone ...
Background
Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder primarily characterized by fine and gross motor coordination difficulties. Yet, many aspects remain unclear regarding the clinical presentation of secondary symptoms and their implications for Clinical Psychology. Therefore, the purpose of this review is to provide an update about the current understanding of DCD for clinical psychologists and psychotherapists across Europe, particularly based on new insights stemming from the last decade of research.
Method
We provide a narrative review of articles published in the last decade on the topic of DCD, and relevant aspects to clinical psychologist, including lesser known aspects of DCD (e.g., executive functions, psychological consequences, and adult DCD).
Results
DCD is a highly prevalent, disruptive, and complex disorder, which should be investigated further in many areas (e.g., co-occurrence to ADHD). Existing evidence points toward a key role of executive functioning difficulties at all ages. Most patients report secondary psychological problems, but little headway has been made in examining the effectiveness of psychotherapy for DCD.
Conclusions
Insights and remaining research gaps are discussed. It is critical for psychologists and clinical researchers to raise awareness for DCD, take note of the growing literature, and foster continued interdisciplinary approaches to research and treatment of DCD.
... Others consider the motor dysfunction found in DCD and ASD to be different in nature [310,417]. In a systematic review, Cacola et al. [66] showed that while DCD and ASD share some behavioural symptoms, distinctions have been shown in terms of gestural performance, severity of motor challenges and grip selection. Finally, motor disturbances appear to be among the first manifestations of developmental abnormalities in ASD and could serve as markers of the condition in the first years of life before other core symptoms (i.e., social communication, restricted interests) [168,303]. ...
... Others consider the motor dysfunctions found in DCD and ASD to be different in nature from one another [310,417]. In a systematic review, Cacola et al. [66] showed that, while DCD and ASD share some behavioural symptoms, distinctions exist in terms of gestural performance, severity of motor challenges, and grip selection. Finally, motor disturbances appear to be among the first manifestations of developmental abnormalities in ASD and could serve as markers of the condition in the first years of life before other core symptoms (i.e., social communication, restricted interests) are visible [168,303]. ...
Handwriting difficulties are frequent and impairing. However, the assessment of motor learning is difficult and limits early stage rehabilitation.
Electronic sensors and algorithms can help to measure motor difficulties more easily and objectively. Electronic tablets, for instance, give access to handwriting features that are not usually evaluated in classical assessments. We describe how such digital features (in static, dynamic, pressure, and tilt domains) allow diagnosing dysgraphia and how they evolve during children development. From a finer analysis, three different clusters of dysgraphia emerge. We hope that future longitudinal studies will allow to underline different patterns of development that seemingly require tailored remediation strategies.
However, those digital features are not used in the context of conventional pen and paper therapies. It is possible to engage typically developping children in handwriting ex- ercises by asking them to teach a robot to write. We implemented a long-term case study (20 sessions, 500 minutes in total) observing a child with severe Developmental Coordi- nation Disorder who did not progress anymore with a classic pen and paper approach by enriching this setup with various training activities using real-time feedback loops (on tilt, pressure, dynamic, pauses). We show how this new method tackles the child’s previous behavior avoidances, boosting his motivation, and improving his motor and writing skills.
This thesis demonstrates how new writing digital features allow the implementation of innovative handwriting remediation interventions, which rely on fostering children’s personal characteristics and adaptation skills.
... 89 Moreover, although to-date the DSM-5 criteria specifically allow children to hold a dual diagnosis of ASD and DCD, there is still a lack of consensus in the field about whether DCD and ASD are distinct disorders with some shared motor features, or whether some individuals with ASD have DCD while others do not. 96 In the absence of norms that differentiate motor performance of ASD and DCD, clinicians may find it challenging to determine whether the motor ability of the child impacts daily functioning above and beyond the core impairments associated with ASD as required by the DSM-5; consequently, dual diagnosis is rarely given. 96 This type of misdiagnosis may prevent access to appropriate treatment that can promote participation of ASD children and adolescents in sports, playground games, and other leisure and daily activities. ...
... 96 In the absence of norms that differentiate motor performance of ASD and DCD, clinicians may find it challenging to determine whether the motor ability of the child impacts daily functioning above and beyond the core impairments associated with ASD as required by the DSM-5; consequently, dual diagnosis is rarely given. 96 This type of misdiagnosis may prevent access to appropriate treatment that can promote participation of ASD children and adolescents in sports, playground games, and other leisure and daily activities. ...
This comprehensive thematic review aims to highlight and familiarize readers with the challenges and pitfalls encountered in differential diagnosis of autism spectrum disorders (ASD) in children to facilitate the process of accurate identification by stake-holders. Accordingly, articles that best answer our questions and highlight our concerns were chosen from well-established publishers with prime peer reviewed journals. Included are studies showing alternate views of the issues so as to point readers to other possibilities. ASD, a complex dynamic biological-neurodevelopmental disorder, is underscored by its heterogeneous symptomology, severity, and phenotypes-all characterized by social communication deficits and presence of restricted interests and repetitive behaviours (RRBs), the core symptoms in ASD. Language and intellectual capacities do not form ASD core symptoms although vary considerably. Accurate identification is challenging as ASD is often enmeshed with other neurodevelopmental disorders, and medical comorbidities, a situation now recognized as the rule rather than the exception in child psychiatry and developmental medicine. ASD is a disorder with varying performance and severity of symptoms over time, including unexpected loss of early skills, and lost diagnosis in some children following treatment. The review reiterates the urgency in accurate diagnosis in face of the rapid rise in ASD prevalence globally, and risk-increase in delayed or denied treatment with undesirable lifelong consequences for most of the affected children. In addition, a call for change is advised to circumvent the ethical dilemma posed by the present "deficit model" in ASD diagnosis. Here, ASD prevalence is presented first, followed by emphasis on importance of accurate early diagnosis, and challenges in its accomplishment due to flaws in diagnostic instruments and other contributing factors. Next follow the required criteria for accurate identification, and its difficulties attributed to comorbid conditions, gender differences , and socioeconomic and cultural influences. The conclusion includes future directions and a take away message.
... Given any abnormal IPS patterns (Georgescu et al., 2020) might merely be due to a high prevalence of motor difficulties in ASD (Dziuk et al., 2007;Parma & de Marchena, 2016;Vanvuchelen et al., 2007), we additionally assessed dyspraxia in the studied population. Even though motor difficulties do not currently form a part of the diagnostic criteria, recent changes in the Diagnostic Manual for Mental Disorders (DSM-5; American Psychiatric Association, 2013) allow for ASD and developmental coordination disorder (DCD or dyspraxia) to be diagnosed as co-occurring conditions (Caçola et al., 2017). DCD is characterized by significant impairments in performing gross-and fine motor skills, coordination and balance at an age-appropriate level. ...
... DCD is characterized by significant impairments in performing gross-and fine motor skills, coordination and balance at an age-appropriate level. Though it is suggested that the symptom profiles of each disorder are separable (Caçola et al., 2017), the official recognition as potential comorbidity points towards considerable motor impairments in many individuals with ASD. While approximately 80% of children with ASD are suspected to exhibit pronounced motor difficulties (Green et al., 2009), the body of evidence on autistic adults in this area is surprisingly small. ...
Reliably diagnosing autism spectrum disorders (ASD) in adulthood poses a challenge to clinicians due to the absence of specific diagnostic markers. This study investigated the potential of interpersonal synchrony (IPS), which has been found to be reduced in ASD, to augment the diagnostic process. IPS was objectively assessed in videos of diagnostic interviews in a representative referral population from two specialized autism outpatient clinics. In contrast to the current screening tools that could not reliably differentiate, we found a significant reduction of IPS in interactions with individuals later diagnosed with ASD (n = 16) as opposed to those not receiving a diagnosis (n = 23). While these findings need to be validated in larger samples, they nevertheless underline the potential of digitally-enhanced diagnostic processes for ASD.
... Although the observed motor problems are similar in nature and severity, there may be differences in the precise nature of these impairments (Miller et al. 2019) and their underlying neural pathways (Caeyenberghs et al. 2016). In an effort to synthesize the existing body of knowledge on the relationship between these two disorders, we recently published a systematic literature review highlighting the differences and similarities among individuals diagnosed with ASD (without DCD) versus DCD (without ASD) (Caçola et al. 2017). This review supported previous assertions that ASD and DCD are two distinct NDDs with clear differences in the areas of working memory ability, gestural performance, and grip selection, but with shared motor features. ...
... While we had lower than optimal power, the proportion of cases in the DCD group who were classified as "Indication of DCD or Suspect DCD" on the DCD-Q, "Red Zone" on the MABC-2, and below average on the Beery VMI/VP/MC were similar to the proportion observed in the ASD group, and followed the same pattern of proportions across categories. This striking result reinforces the similarity of functional motor impairment across the two populations as observed in prior work (for review, see Caçola et al. 2017; also see Bhat 2020), despite the small total number of observations in our study. ...
Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diagnostic criteria for Developmental Coordination Disorder (DCD). We aimed to determine whether motor problems in ASD represent the possible co-occurrence of DCD. We retrospectively reviewed standardized assessments and parent-reports to evaluate motor ability in 43 individuals with ASD against diagnostic criteria for DCD, and compared to 18 individuals with DCD. Over 97% of cases in the ASD group scored below the 16th percentile in motor ability, with most below the 5th percentile. Over 90% of cases in the ASD group met criteria for co-occurring DCD. Motor challenges are a clinically-significant problem in ASD; systematically assessing the prevalence of co-occurring ASD + DCD is necessary to optimize assessment and intervention.
... Results from a systematic review showed that the motor coordination deficits is so prevalent in children with ASD that might be considered a cardinal feature in this children (Fournier et al., 2010). Another systematic review concluded that the children with ASD and DCD shared similar deficits in motor skills (Caçola et al., 2017). ...
This article comprehensively reviews motor impairments in children with autism spectrum disorder (ASD) to: (1) determine the prevalence of motor problems in children with ASD; (2) understand the nature of motor difficulties in ASD and whether they are consistent with developmental coordination disorder (DCD); and (3) determine if the term DCD was used as a co-occurring diagnosis in children with ASD after publication of the DSM-5 in 2013. The following databases were systematically searched: MEDLINE, EMBASE, CINAHL, and PsycINFO from 2010 to December 2021. Articles were included if they: (1) were peer-reviewed and published in a scientific journal; (2) included children with ASD who were between 5 and 12 years; (3) used motor or function measures to assess motor abilities in children with ASD. Studies that included children with intellectual disabilities were excluded. Two independent reviewers reviewed titles, abstracts, and full-text articles for inclusion. Twenty-seven studies met the inclusion criteria and were assessed for quality by two independent reviewers using the Appraisal tool for Cross-Sectional Studies. The majority of articles (92.5%) indicated that 50–88% of children with ASD had significant motor impairments on standardized motor assessments and/or functional questionnaires. The nature of motor and function problems in ASD were consistent with DCD; however, only three out of 20 papers (15%) that were published from 2014 described the motor problems as DCD. One study reported that 15.1% of children with ASD with motor impairments had a co-occurring diagnosis of DCD, suggesting that DCD is under-recognized in this clinical population.
... Complicating diagnosis further, many autistic individuals have other conditions potentially associated with slower processing speed. Such comorbid conditions may include, e.g., attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder, anxiety disorders, developmental coordination disorder, and language impairments (Caçola et al., 2017;Simonoff et al., 2008;Tager-Flusberg, 2016). Given study documentation, it was not possible to know the extent to which participants in the included studies had co-morbid conditions affecting attention, language, motor, and intellectual abilities. ...
Purpose
Individuals with developmental language disorder (DLD) often exhibit slower processing on time-based tasks in comparison with age-matched peers. Processing speed has been linked to various linguistic skills and might serve as a global indicator of individual differences in language abilities. Despite an extensive literature on processing speed in DLD, it remains unclear whether slower processing is domain general or restricted to linguistic and/or auditory tasks.
Method
This meta-analysis used robust variance estimation to compare response/reaction times (RTs) of DLD and age-matched groups ( N = 812 DLD, 870 neurotypical; M age [DLD] = 8.9 years, range: 4.3–22.7 years). Moderators included task (simple RT, choice RT, naming, congruent/baseline conditions of interference control tasks), stimulus type (linguistic/nonlinguistic), stimulus modality (auditory/nonauditory), and response modality (verbal/nonverbal). Age and publication year were covariates.
Results
The overall effect based on 46 studies and 144 estimates indicated longer mean RTs in DLD groups ( g = .47, p < .001, 95% CI [.38, .55]). Moderator analyses indicated larger effects when tasks required verbal as opposed to nonverbal responses. No other moderators approached significance. All subgroup analyses were significant, indicating longer mean RTs in DLD groups across tasks, stimulus types, stimulus modalities, and response modalities.
Conclusions
Individuals with DLD exhibit longer RTs across verbal and nonverbal tasks, which may contribute to observed difficulties in language, motor skills, and executive functioning. Simple processing speed measures should be included in screening for language delays but may not be suitable for differential diagnosis, given that slower processing may occur across multiple disorders.
Supplemental Material
https://doi.org/10.23641/asha.21809355
... Performance on motor skills, such as balance, manual dexterity, and ball skills, are generally equally poor in ASD and DCD groups compared to typically developing groups (TD; Caçola et al., 2017;Kilroy et al., 2022). By contrast, praxis performance encompassing skilled limb gestures (e.g., gesture-to-command, tool use, imitation;Crucitti et al., 2019), often differs between ASD and DCD groups, with ASD performing worse (Dewey et al., 2007;Kilroy et al., 2022). ...
This study aimed to better understand how autism spectrum disorder (ASD) and developmental coordination disorder (DCD) differ in types of praxis errors made on the Florida Apraxia Battery Modified (FAB-M) and the potential relationships between praxis errors and social deficits in ASD. The ASD group made significantly more timing sequencing errors in imitation of meaningful gestures, as well as more body-part-for-tool errors during gesture-to-command compared to the other two groups. In the ASD group, increased temporal errors in meaningful imitation were significantly correlated with poorer affect recognition and less repetitive behaviors. Thus, in ASD, aspects of imitation ability are related to socioemotional skills and repetitive behaviors.
... Moreover, comorbidities between autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are welldocumented [1], and have been formally recognised by the DSM-5 [2]. Co-occurrences between ADHD and developmental coordination disorder (DCD) may occur in as many as 50% of cases [3], while poor motor coordination is observed in both ASD and DCD [4]. That is, ASD, ADHD, and DCD appear to share behavioural symptoms, which may be underpinned by common cerebellar morphological alterations. ...
Alterations in cerebellar morphology relative to controls have been identified in children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and developmental coordination disorder (DCD). However, it is not clear if common cerebellar regions are affected in each neurodevelopmental disorder and whether cerebellar morphological changes reflect a generic developmental vulnerability, or disorder-specific characteristic. The present study concatenated anatomical MRI scans from five existing cohorts, resulting in data from 252 children between the age of 7 and 12 years (ASD = 58, ADHD = 86, DCD = 22, Controls = 86). The ACAPULCO processing pipeline for cerebellar segmentation was conducted on T1-weighted images. A voxel-wise approach with general linear model was used to compare grey-matter volume of the 27 cerebellar lobules between each clinical group and controls. Our findings revealed that the ADHD group showed lower grey-matter volume in the left Crus I – part of the executive/non-motor portion of the cerebellum, relative to controls (p = 0.02). This no longer remained significant after controlling for medication status. There were no regions of significant differences in volume of the cerebellar lobules in ASD or DCD compared to controls. Future work will conduct harmonisation of behavioural data (cognitive and motor outcomes) across cohorts, enabling more advanced analyses to identify symptom cluster across neurodevelopmental disorders.
... Complicating diagnosis further, many autistic individuals have other conditions potentially associated with slower processing speed. Such comorbid conditions may include, e.g., attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder, anxiety disorders, developmental coordination disorder, and language impairments (Caçola et al., 2017;Simonoff et al., 2008;Tager-Flusberg, 2016). Given study documentation, it was not possible to know the extent to which participants in the included studies had co-morbid conditions affecting attention, language, motor, and intellectual abilities. ...
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition affecting information processing across domains. The current meta-analysis investigated whether slower processing speed is associated with the ASD neurocognitive profile and whether findings hold across different time-based tasks and stimuli (social vs. nonsocial; linguistic vs. nonlinguistic). Mean RTs of ASD and age-matched neurotypical comparison groups (N = 893 ASD, 1063 neurotypical; mean age ASD group = 17 years) were compared across simple RT, choice RT, and interference control tasks (44 studies, 106 effects) using robust variance estimation meta-analysis. Simple RT tasks required participants to respond to individual stimuli, whereas choice RT tasks required forced-choice responses to two or more stimuli. Interference control tasks required a decision in the context of a distractor or priming stimulus; in an effort to minimize inhibitory demands, we extracted RTs only from baseline and congruent conditions of such tasks. All tasks required nonverbal (motor) responses. The overall effect-size estimate indicated significantly longer mean RTs in ASD groups (g = .35, 95% CI = .16; .54) than comparison groups. Task type moderated effects, with larger estimates drawn from simple RT tasks than interference control tasks. However, across all three task types, ASD groups exhibited significantly longer mean RTs than comparison groups. Stimulus type and age did not moderate effects. Generalized slowing may be a domain-general characteristic of ASD with potential consequences for social, language, and motor development. Assessing processing speed may inform development of interventions to support autistic individuals and their diverse cognitive profiles.
... Moreover, an fMRI study suggested that tactile TOJs share neural bases with motor controls (Miyazaki et al., 2016). Individuals with ASD frequently exhibit developmental coordination disorder (Cacola et al., 2017), some of which may be explained by impairments in the learning of Bayesian priors. ...
Previous psychophysical studies reported a positive aftereffect in tactile temporal order judgments, which can be explained by the Bayesian estimation model (‘Bayesian calibration’). We investigated the relationship between Bayesian calibration and autistic traits in participants with typical development (TD) and autism spectrum disorder (ASD). Bayesian calibration was weakened in TD participants with high autistic traits, consistent with the ‘hypo-priors’ hypothesis for autistic perceptions. The results from the ASD group were generally observed as a continuation of those from the TD groups. Meanwhile, two ASD participants showed irregularly large positive or negative aftereffects. We discussed the mechanisms behind the general results among TD and ASD participants and two particular results among ASD participants based on the Bayesian estimation model.
... Others consider the motor dysfunctions found in DCD and ASD to be different in nature from one another [148,206]. In a systematic review, Cacola et al. [29] showed that, while DCD and ASD share some behavioural symptoms, distinctions exist in terms of gestural performance, severity of motor challenges and grip selection. Finally, motor disturbances appear to be among the first manifestations of developmental abnormalities in ASD and could serve as markers of the condition in the first years of life before other core symptoms (i.e. ...
Autism spectrum disorder (ASD) is mainly described as a disorder of communication and socialization. However, motor abnormalities are also common in ASD. New technologies may offer quantitative and automatic metrics to measure movement difficulties. We sought to identify computational methods to automatize the assessment of motor impairments in ASD. We systematically searched for the terms ’autism’, ’movement’, ’automatic’, ’computational’ and ’engineering’ in IEEE (Institute of Electrical and Electronics Engineers), Medline and Scopus databases and reviewed the literature from inception to 2018. We included all articles discussing: (1) automatic assessment/new technologies, (2) motor behaviours and (3) children with ASD. We excluded studies that included patient’s or parent’s reported outcomes as online questionnaires that focused on computational models of movement, but also eye tracking, facial emotion or sleep. In total, we found 53 relevant articles that explored static and kinetic equilibrium, like posture, walking, fine motor skills, motor synchrony and movements during social interaction that can be impaired in individuals with autism. Several devices were used to capture relevant motor information such as cameras, 3D cameras, motion capture systems, accelerometers. Interestingly, since 2012, the number of studies increased dramatically as technologies became less invasive, more precise and more affordable. Open-source software has enabled the extraction of relevant data. In a few cases, these technologies have been implemented in serious games, like “Pictogram Room”, to measure the motor status and the progress of children with ASD. Movement computing opens new perspectives for patient assessment in ASD research, enabling precise characterizations in experimental and at-home settings, and a better understanding of the role of sensorimotor disturbances in the development of social cognition and ASD. These methods would likely enable researchers and clinicians to better distinguish ASD from other motors disorders while facilitating an improved monitoring of children’s progress in more ecological settings (i.e. at home or school).
... Despite these findings, motor skills in ASD are relatively unexamined, particularly the relationship between motor skills, communication, and interaction. Several studies have described motor interventions that may benefit children with ASD, such as aquatic programs (Pan, 2011), karate techniques (Bahrami Effect of physical therapy on children with ASD et al., 2016), or specific rehabilitation physical therapy, such as dance movement therapy (DMT) (Belmonte et al., 2013;Caçola et al., 2017;Vaysse, 2006). Previous literature suggests that physical therapy, such as DMT, may benefit children with ASD by developing various movements and trust in others, improving social and communicative skills as well as gross and fine motor skills, and contributing to the improvement of memory, recapitulation abilities, awareness of the body, and general well-being (Lesauvage, 2010). ...
More than half of children who have autism spectrum disorder (ASD) suffer from motor impairment. In a retrospective study, the authors investigated the effect of a body-mediated workshop with dance movement therapy (DMT) on the motor skills and social skills of children with ASD by comparing 10 autistic children aged 7 to 10 years who benefited from DMT with 10 autistic children in a control group. Scores on the Movement Assessment Battery for Children and the Vineland Adaptive Behavior Scale were compared. The body-mediated workshop had significant benefits for motricity, especially manual dexterity, and for relational skills. A body-mediated workshop may have a multimodal effect and requires transmodal training. Regarding the mechanisms that explain the benefits and the cascading effect, the roles of imitation and multimodal connections are important.
... It is well established that multimorbidity is extremely frequent in neurodevelopmental disorders (Dewey & Bernier, 2016). Motor problems seem to fulfil a role as a transdiagnostic symptom across different neurodevelopmental disorders, as they are not necessarily unique to ASD and the observed difficulties are often comparable to those observed in Developmental Coordination Disorder (DCD) (Caçola et al., 2017;Hannant et al., 2018;Hilton et al., 2012;McPhillips et al., 2014;Miller et al., 2021;Paquet et al., 2019;Sumner et al., 2016). In contrast, there is also a subset of individuals with ASD who do not demonstrate motor problems. ...
Although motor problems are highly prevalent in children with autism spectrum disorder (ASD), they remain underdiagnosed. Questionnaire-based screening for motor problems could optimize current clinical practice. This study aimed to examine the psychometric properties of the developmental coordination disorder questionnaire (DCDQ) to screen for co-occurring motor problems in individuals with ASD (n = 115; aged 5–15 years). Results indicated an excellent internal consistency; concurrent and discriminant validity with the Movement Assessment Battery for Children, second edition. Sensitivity was excellent, but specificity was lower. The positive and negative predictive values indicate that the DCDQ can be used to detect motor problems in children with ASD and can exclude the presence of developmental coordination disorder.
... Indeed, Blank et al. (2019) has noted that Developmental Coordination Disorder (DCD), an under-studied concern, is often associated with ASD and other neurodevelopmental disorders (Blank et al., 2019). While descriptions of motor differences are found in the earliest descriptions of ASD, researchers have only recently begun to better understand and specify the underlying motor deficits in ASD (e.g., (Blank et al., 2019;Cacola et al., 2017)) that may assist its early detection and remediation. For instance, muscle weakness is believed to be one of the earliest ASD motor signs (Bhat et al., 2011). ...
Autism spectrum disorder (ASD) is a complex diagnosis characterized primarily by persistent deficits in social communication/interaction and repetitive behavior patterns, interests, and/or activities. ASD is also characterized by various physiological and/or behavioral features that span sensory, neurological, and neuromotor function. Although problems with lower body coordination and control have been noted, little prior research has examined lower extremity strength and proprioception, a process requiring integration of sensorimotor information to locate body/limbs in space. We designed this study to compare lower limb proprioception and strength in adolescents with ASD and neurotypical controls. Adolescents diagnosed with ASD (n = 17) and matched controls (n = 17) performed ankle plantarflexion/dorsiflexion bilateral proprioception and strength tests on an isokinetic dynamometer. We assessed position-based proprioception using three targeted positions (5 and 20-degrees plantarflexion and 10-degrees dorsiflexion) and speed-based proprioception using two targeted speeds (60 and 120-degrees/second). We assessed strength at 60-degrees/second. Participants with ASD performed 1.3-times more poorly during plantarflexion position and 2-times more poorly during the speed-based proprioception tests compared to controls. Participants with ASD also exhibited a 40% reduction in plantarflexion strength compared to controls. These findings provide insight into mechanisms that underly the reduced coordination, aberrant gait mechanics, and coordination problems often seen in individuals with ASD, and the identification of these mechanisms now permits better targeting of rehabilitative goals in treatment programs.
... Therefore, its use was not suitable for the present study. Since we could not find a tool giving standardized criteria for assessing the quality of neuropsychological and behavioral studies, we adapted the NOS based on the methods used by Wu et al. [53][54][55] and Caçola et al. [56], that were inspired by the NOS and the PRISMA standards. We developed three to four quality items for each domain of the NOS (selection, comparability and outcome). ...
Developmental coordination disorder (DCD) is a neurodevelopmental disorder affecting primarily motor skills, but attentional and executive impairments are common in affected individuals. Moreover, the presence of neurodevelopmental comorbidities is frequent in this population, which certainly influences the cognitive profile of the children concerned. Previous studies have reported deficits in visuospatial/nonverbal and planning tasks. This systematic review of the literature aims to determine if impairments can be found in other attentional and executive functions as well. The type of cognitive tasks, the tasks’ modality (verbal/nonverbal), and the influence of comorbid disorders on attentional and executive profiles are systematically considered. Forty-one studies were identified through the PubMed/Medline and PsycINFO databases according to pre-established eligibility criteria. The results reveal weaknesses in inhibitory control, working memory, planning, nonverbal fluency, and general executive functioning in children with DCD. The presence of comorbid disorders seemingly contributes to the verbal working memory difficulties findings. This review contributes to a better understanding of the cognitive impairments in DCD and of the needs of children with this disorder, allowing to optimize practitioners’ therapeutic interventions.
... Due to recent changes in the Diagnostic and Static Manual for Mental Disorders-Fifth Edition (DSM-5, 2013), ASD and DCD can be diagnosed as co-occurring in certain individuals (Caçola, Miller, & Williamson, 2017). Impaired empathy is considered a marked feature of ASD (Baron-Cohen & Wheelwright, 2004). ...
Date Presented 03/26/20
Adults with DCD only or DCD with co-occurrence reported significantly lower success in past (late adolescent) social relationships, compared to typically developing adults. Yet in adulthood, the DCD-only group did not differ significantly from the typically developing group in social relationships. Adults with DCD appear to have more positive social experiences than they did in adolescence. The results suggest a unique contribution of different patterns of neurodevelopmental co-occurrence with DCD in adulthood.
Primary Author and Speaker: Miri Tal-Saban
Contributing Authors: Amanda Kirby
... Autism Spectrum Disorder (ASD) is a Neurodevelopmental Disorder that is manifested during the developmental period, [1]. The prevalence of Autism has been increased in recent years due to several biopsychosocial and environmental factors along with a change in diagnostic criteria and improvement in diagnosis [2] [3], and [4]. According to [5]. ...
BACKGROUND
The use of Information Communication Technologies (ICT) in education promising from decades ago. There has been rapid development of different ICT tools to improve the quality of life of children with Autism Spectrum Disorders (ASD). However, the process of developing a user friendly and effective tool such as mobile application needs to follow complex standard protocol, culture-sensitive customization, and multisectoral involvements. This complex work becomes more challenging for children with ASD in Low and Middle-Income Countries.
OBJECTIVE
This study aimed to develop a user-friendly mobile application for children with autism to improve numeracy skills in Rwanda.
METHODS
The application was developed through participatory action research involving educators and human-computer interaction researchers, subject matter expert clinicians, and target users. A comprehensive beta testing version of the application was developed that considered educators' feedback from focus groups, and observations of children with ASD when using the application.
RESULTS
In the findings of this study, the participants suggested three points to consider when designing the interface for children with ASD. (1) Graphic design principals, (2) User interface design, and (3) Success recognition and messages. The mobile application is believed to assist parents and educators to train and educate children with ASD to be able to learn, memorize and recognize the numbers that figure on coins used in Rwandan currency and participate in different economic activities in their families.
CONCLUSIONS
Overall, it has become clear that it is possible to develop mobile applications that respond to the needs of children with Autism Spectrum Disorders to eliminate the barrier of learning mathematical skills. Empowering skills of the use of ICT in teaching and support of learners with ASD inclusive environment can also bring the idea of features to be added into the developed application. This underscores the relevance of the needs of more assistive technologies to be developed in the response of each societal problems
... In addition, people with ASD may have motor deficits characterized by poor motor coordination, atypical gait, and other abnormal motor signs such as tiptoe walking (APA, 2014). In fact, according to Caçola, Miller and Williamson (2017), problems of movement accuracy, motor coordination and balance are often observed in children with ASD. Kanner (1943) also found motor deficiencies to be common symptoms of ASD. ...
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent impairments in communication and social interaction and restricted and repetitive patterns of behavior, interests or activities. Evidence points to a significant increase in the number of cases worldwide. Motor impairments in people with ASD are evidenced in numerous studies, but the real cause of this impairment is still a source of discussion in the literature. The aim of this study was to evaluate and correlate motor, intellectual and executive function performance in children diagnosed with ASD. Eighteen children and adolescents with a medical diagnosis of ASD, aged between 9 and 13 years, were evaluated. For the evaluations, the Movement Assessment Battery for Children (MABC-2) scales were used for motor evaluation, Wechsler Abbreviated Intelligence Scale-WASI, cognitive evaluation, Trail Test: Parts A and B aiming at cognitive flexibility and the Attention Test by Cancellation-TAC. The results indicate that 67% of the studied sample had severe motor difficulties in all studied skills and significant correlations between the intellectual level and executive functions (rho = 0.907; 0.713), suggesting that the greater the impairment of executive functions and capacity the greater the impairment of motor skills. Copyright © 2020, Ariane Cristina Ramello de Carvalho et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
... Yet findings relating to visual-motor integration in ASD when using the Beery VMI have been inconsistent, with some studies indicating differences (Hellinckx, Roeyers, & Van Waelvelde, 2013;Miller, et al., 2014) but others showing no difference when controlling for IQ (Green et al., 2016). The mixed findings in ASD populations, however, may be due to low sensitivity of the measures that have been used to index visual-motor integration (Caçola, Miller, & Williamson, 2017). ...
Even with the increasing use of technology in the classroom, handwriting remains a developmental foundation of education. When children fail to learn to write efficiently, they encounter cascading difficulties in using writing to communicate and learn content. Traditionally, the development of handwriting has been studied via neuropsychological testing or the moment-to-moment kinematics of pen movements. By measuring children’s handwriting with neuropsychological testing, investigators have determined that children’s visual-motor integration abilities predict children’s handwriting. Further, by measuring children’s pen movements while writing, investigators have determined that children’s handwriting becomes more fluent as they become skilled writers. Both of these literatures have advanced our understanding of handwriting substantially, but fall short of providing a full account of handwriting development. Here, we offer a perception–action account of handwriting development by describing how eye and hand movements become integrated during early writing. We describe how head-mounted eye-tracking technology can be used to measure children’s eye movements as they write in real-time. We illustrate this approach with findings from research on letter, form, and word copying in school-entry age children. We conclude by discussing how a perception–action approach can be extended for use with atypical populations.
... This has led to the hypothesis that dysfunction in the MNS might be a core deficit underlying deficits in social behavior like in ASD (Iacoboni and Dapretto, 2006). Compromised MNS function in DCD may, therefore, add to the debate concerning the possible overlap between the sensorimotor and cognitive problems of children with DCD and children with ASD (Williams et al., 2001;Caçola et al., 2017). An interesting question is whether a dysfunctional MNS in DCD is specific to motor learning or if other functions that rely on a well-functioning MNS might be affected as well. ...
Children with Developmental Coordination Disorder (DCD) have difficulty performing and learning motor skills. Automatic activation of the mirror neuron system (MNS) during action observation and its coupling to the motor output system are important neurophysiological processes that underpin observational motor learning. In the present study, we tested the hypothesis that MNS function is disrupted in children with DCD by using sensitive electroencephalography (EEG)-based measures of MNS activation during action observation. Specifically, we predicted reduced mu-suppression and coherence in DCD compared with typically developing children. Neural activation of the motor network was measured by EEG, specifically event-related desynchronization (ERD) of mu rhythms and fronto-parietal coherence. Children (15 DCD/15 controls) were tested under two task conditions: observational learning (imitation of an observed action) and detection (report a deviant movement after observation). EEG-metrics were compared between groups using linear mixed-effects models. As predicted, children with DCD showed lower levels of mu suppression and reduced modulation of coherence during the observational learning task compared with their non-DCD peers. Notably, mu suppression was reduced in DCD over the entire imitation task (repetitions, and both observation and pause intervals). Action observation can be used for the acquisition of new motor skills. This form of learning entails the transposition of the observed action to the existing internal representations of the observer’s own motor system. The present neurophysiological results suggest that this process of learning is impaired in children with DCD. The results are discussed in relation to current hypotheses on mechanisms of DCD.
... Even though DCD is associated with several other difficulties, studies have reported that a significant number of children diagnosed with DCD have also been diagnosed with other developmental disorders, such as learning difficulties 9 , dyslexia 21 , and attention deficit hyperactivity disorder (ADHD) 22 . In addition, the co-occurrence with Autism Spectrum Disorders (ASD) has been recently explored and reported to be high 23 . In fact, comorbidity in DCD is considered to be the "rule" rather than the "exception" 14 , and it is essential for researchers and practitioners to be aware of this fact. ...
Developmental Coordination Disorder (DCD) is a neurodevelopmental condition marked by impairments in the development of motor coordination. The uncoordinated movements of children with DCD lead to performance difficulties in daily life activities and academic settings. Despite the high prevalence of this condition (2-7%) and severe consequences associated with it, DCD is not well recognized in clinical and educational practices, particularly in Brazil. This review provides an overview of DCD and the research evidence - we present definitions and characteristics associated with the condition, the diagnostic criteria, associated difficulties, frequent co-morbidities and a summary of the possible causes. Finally, we review management strategies and intervention approaches for DCD. We also discuss some of the common challenges of the field - while DCD has been largely studied in the last decade, there are still many gaps between research and practice that need to be filled. Awareness and dissemination of relevant, scientific information is necessary. In conclusion, DCD is a significant condition with a clear diagnostic criteria, and requires intervention to improve motor and functional skills, which can improve the associated difficulties as well as the physical and mental health consequences of the condition.
... Due to recent changes in the Diagnostic and Static Manual for Mental Disorders-Fifth Edition (DSM-5, 2013), ASD and DCD can be diagnosed as co-occurring in certain individuals (Caçola, Miller, & Williamson, 2017). Impaired empathy is considered a marked feature of ASD (Baron-Cohen & Wheelwright, 2004). ...
Empathy is defined as an emotional or cognitive response to another's emotional state. It is considered essential for navigating meaningful social interactions and is closely linked to prosocial behavior. Developmental coordination disorder (DCD) is characterized by an impairment of motor coordination that has a marked impact on both academic and day-to-day living activities. Children and adolescents with DCD have been shown to have less developed social support and friendships. The research linking empathy and DCD is scarce. The aims of this study are to gain an understanding of the relationship between DCD and empathy in young adults with DCD only, and with DCD coupled with other neurodevelopmental disorders, in comparison with typically developing adults.
Methods:
The study included 212 young adults aged 18-40 years. The subjects in this study were from mainstream populations in the UK. The study groups included: (a) "DCD only" with 42 individuals; (b) "DCD + ASD" with 21 individuals; (c) "DCD + ADHD" with 45 individuals; (d) "DCD + ASD + ADHD" with 29 individuals; and (e) the control group of 75 individuals.
Results:
ANOVA on the Empathy Questionnaire (EQ) showed a statistically significant difference between groups (F [4,257] = 35.63; p < 0.001; ηp2 = 0.409). No significant differences were found between the DCD-only and the control. MANOVA was performed to assess differences in the Socialising and Friendship Questionnaire (SAF-Q) scores. The results showed a statistically significant difference between groups (F [8,257] = 9.98; p < 0.001; η = 0.162). Pearson correlation coefficients were performed, revealing significant high correlations between the EQ and the two parts of the SAF-Q ("past" and "currently").
Conclusion:
The results of this study indicate that social difficulties in the DCD-only group are not due to lack of empathy, but may be driven by an accumulation of external factors. In this study we also concluded that DCD does not appear to be the factor that reduces the ability to empathize, but rather the presence of ADHD and/or ASD.
... At the same time, it has been observed clinically for some time that children with neurodevelopmental disorders such as ADHD/ADD or ASD, typically present with motor impairments (Cairney and King-Dowling, 2016). Evidence from a recent systematic review suggests that behaviorally DCD and ASD are separate, but possibly co-occurring, conditions with differences in many behavioral domains (Caçola et al., 2017); however, these findings are limited by the lack of studies reporting on children with co-occurring diagnoses of ASD and DCD. Indeed, the removal of ASD as an exclusion from DCD has opened the door for more serious inquiry into co-occurring, motor, cognitive, communicative and social impairments in children who present with neurodevelopmental disorders such as ASD. ...
Objective: Children with autism spectrum disorder (ASD) experience significant challenges with their motor coordination. It is not, however, well understood how motor coordination may impact the behavioral functioning of children with ASD. Therefore the purpose of this study was to explore the relationships between motor coordination and adaptive behavior in 7–12-year-old children with ASD.
Methods: Motor coordination was assessed using the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and adaptive behavior was assessed by parental report using the Vineland Adaptive Behavior Scales, 2nd Edition (VABS-2) as part of a larger cross-sectional study. Descriptive characteristics were calculated for MABC-2 and VABS-2 scores and Spearman’s rank order correlation analyses were used to examine the relationship between motor coordination and adaptive behavior.
Results: On average, the participants (n = 26) exhibited significant challenges in regard to their motor coordination with all but two participants classified as having significant motor impairments by scoring at or below the 16th percentile on the MABC-2. Results from the correlation analyses indicated that manual dexterity was positively related to daily living skills (ρ = 0.58, p < 0.003), and overall motor coordination was positively related to daily living skills (ρ = 0.60, p < 0.003) and overall adaptive behavior (ρ = 0.57, p < 0.003). In all instances, better motor coordination was related to more adaptive behaviors.
Conclusion: These results highlight the profound motor coordination challenges that children with ASD experience and also suggest that these challenges, particularly with manual dexterity, are related to the daily behavior of children with ASD. The interrelatedness of motor and adaptive behavior suggests the need to further explore the impact of motor-based interventions for this population, as well as conduct longitudinal studies to disentangle these relationships.
... Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) share similar behavioral and motor symptoms, but are not commonly studied together [1]. Children with ASD and DCD have poor postural control compared to TD children [2,3], and are at higher fall and injury risk [4,5]. ...
Background:
Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) are developmental disorders with distinct definitions and symptoms. However, both conditions share difficulties with motor skills, including impairments in postural control. While studies have explored postural sway variables in children with DCD and ASD as compared to typical development (TD), few have used kinematic data to assess the magnitude of differences between these two neurodevelopmental conditions. There are few sensitive and specific measures available to assess balance impairment severity in these populations.
Research question:
Do individuals with ASD, DCD, and TD differ in dynamic postural control?
Methods:
We quantified postural control differences between ASD, DCD, and TD during a dynamic balance task. 10 ASD, 10 DCD, and 8 TD agematched children completed a dynamic postural control task in a virtual environment. They leaned to shift their center of pressure (CoP) to match a user-controlled object to an oscillating target (0.1 Hz-0.8 Hz).
Results:
The DCD group had higher CoP accelerations compared to ASD or TD. While the DCD and TD groups did not differ in their medial-lateral velocity, the ASD group had low medial-lateral velocity and acceleration as compared to DCD and TD. ASD group velocity and acceleration did not differ from that of the TD group in the anterior-posterior direction. Higher accelerations in the DCD group reflected non-fluid movements; by contrast, the ASD group had slower, more fluid movements. Results may reflect differences in how children with ASD and DCD plan, execute, and modify motor actions.
Significance:
This study demonstrates the potential utility of CoP acceleration and velocity as a sensitive and specific means of differentiating between ASD, DCD, and TD. Results indicating group differences between ASD and DCD in velocity and acceleration profiles represent an important step toward understanding how these populations modify motor plans during dynamic tasks.
... It should be stressed that the risk of ASD is not the same as de nitive ASD clinical diagnosis. Furthermore, many authors point to the particularly high prevalence of prematurely-born babies whose positive screening results for ASD are not con rmed in clinical diagnosis [19]. is is especially true for children with various types of health complications, sensory abnormalities and psychomotor development di culties [28,29]. Screening tests may produce falsepositive results in such circumstances [27]. ...
Objective:
Infants ≤28 GA are at particular risk of psychomotor and neurological developmental disorder. They also remain at a higher risk of developing autism spectrum disorder (ASD), characterized by persistent deficits in communication/social interactions and restricted, repetitive behaviors, activities and interests. Monitoring their development by a team of specialists (a neurologist, psychologist, psychiatrist) allows us to make an early diagnosis and to implement appropriate therapy. Neuroimaging studies during the neonatal period may be helpful in clarifying diagnosis and prognosis. Objective: The aim of the study was to search for the interrelation between the results of neuroimaging and the neurological, psychological and psychiatric evaluation at the age of 2.
Patients and methods:
Material and methods: Neonates born at ≤28 weeks between 01.06.2013 and 31.12.2015 and hospitalized at NICU were enrolled. We present the results of the first 12 children who have attained 2 years of corrected age and have undergone both neuroimaging, and neurological, psychological and psychiatric assessments. Transfontanel ultrasound was performed according to general standards, MRI between 38 and 42 weeks of corrected age. Neurological examination based on the Denver scale, ASD screening with use of the STAT test and psychological DSR assessment were performed at 2 years of corrected age.
Results:
Results: Median GA was 26 weeks and median weight 795 g. The ultrasound examination was normal in 9 cases (75%) and MRI in 4 (33%). Abnormalities in the cerebellum were the main additional information found in MRI as compared to US. Neurological examination was normal in 8 infants (67#37;), in 4 of whom neuroimaging was normal. In 4 (33%) infants the neurological examination was abnormal. Psychomotor development at an average level or above was found in seven (58#37;) children. In 4 of them neuroimaging was normal, whereas 3 had ventricular dilatation and haemorrhagic infarct. There were no abnormalities within the cerebellum in this group. In the remaining 5 children (42#37;) psychomotor development was rated as delayed. All of them had cerebellar haemorrhage. An increased risk of ASD was observed in 4 children who developed cerebellar hemorrhage.
Conclusion:
Conclusions: 1. The use of MRI at a term-equivalent age may contribute to the prognosis of neurodevelopmental outcomes in extremely premature infants, allowing risk stratification and thus enhancing early monitoring of a child's development and functional status 2. There is a clear tendency towards abnormal psychomotor development and positive screening for ASD to co-occur with abnormal MRI findings in the cerebellum.
... An example would be Developmental Coordination Disorder (DCD). DCD is a common comorbidity in participants with ASD (Caçola, Miller et al. 2017). Because of the disturbed coordination in individuals with DCD, some results could be contributed to the wrong pathology. ...
Within Autism Spectrum Disorder (ASD) research, little is known concerning motor coordination tasks. Whereas results are inconclusive concerning reaction time of a performed task in comparison to a neurotypical control group, there is evidence of impairments concerning interpretation of visual information. Several hypotheses on the underlying mechanisms of motor limitations in individuals have been suggested but no consensus has been reached yet. Our objective was to investigate the difference in multi-limb coordination between individuals with Autism Spectrum Disorder (ASD) and Neurotypical Adults (NTA).
About 85% of children with autism spectrum disorder (ASD) experience comorbid motor impairments, making it unclear whether white matter abnormalities previously found in ASD are related to social communication deficits, the hallmark of ASD, or instead related to comorbid motor impairment. Here we aim to understand specific white matter signatures of ASD beyond those related to comorbid motor impairment by comparing youth (aged 8–18) with ASD (n = 22), developmental coordination disorder (DCD; n = 16), and typically developing youth (TD; n = 22). Diffusion weighted imaging was collected and quantitative anisotropy, radial diffusivity, mean diffusivity, and axial diffusivity were compared between the three groups and correlated with social and motor measures. Compared to DCD and TD groups, diffusivity differences were found in the ASD group in the mid-cingulum longitudinal and u-fibers, the corpus callosum forceps minor/anterior commissure, and the left middle cerebellar peduncle. Compared to the TD group, the ASD group had diffusivity differences in the right inferior frontal occipital/extreme capsule and genu of the corpus callosum. These diffusion differences correlated with emotional deficits and/or autism severity. By contrast, children with DCD showed unique abnormality in the left cortico-spinal and cortico-pontine tracts.
Trial Registration All data are available on the National Institute of Mental Health Data Archive: https://nda.nih.gov/edit_collection.html?id=2254.
Purpose of review:
This review synthesizes recent, clinically relevant findings on the scope, significance, and centrality of motor skill differences in autism spectrum disorder (ASD).
Recent findings:
Motor challenges in ASD are pervasive, clinically meaningful, and highly underrecognized, with up to 87% of the autistic population affected but only a small percentage receiving motor-focused clinical care. Across development, motor differences are associated with both core autism symptoms and broader functioning, though the precise nature of those associations and the specificity of motor profiles to ASD remain unestablished. Findings suggest that motor difficulties in ASD are quantifiable and treatable, and that detection and intervention efforts targeting motor function may also positively influence social communication. Recent evidence supports a need for explicit recognition of motor impairment within the diagnostic framework of ASD as a clinical specifier. Motor differences in ASD warrant greater clinical attention and routine incorporation into screening, evaluation, and treatment planning.
The influences of including visual supports and strategies to increase motivation for children with autism spectrum disorder (ASD) in motor assessments were examined. 97 children with ASD and 117 age-matched typically developing (TD) children performed the Movement Assessment Battery for Children, Second Edition (MABC-2) under traditional, visual support, motivation, and visual support plus motivation protocols. Results showed that children with ASD elicited lower MABC-2 scores than TD children. Moreover, in children with ASD, the visual support protocol, but not the motivation protocol, produced higher scores on ball and balance skills than the traditional protocol. These findings indicated that children with ASD were developmentally delayed in motor skills; however, their performance may be improved by including visual supports in motor assessments.
Affecting one in 20 children, developmental coordination disorder (DCD) is a common neurodevelopmental disorder that impacts a child’s ability to learn motor skills and significantly interferes with daily life, school performance, and leisure pursuits. While primarily a motor disorder present from early in life, DCD often persists into adulthood and affects physical health, mental health, and quality of life. DCD frequently cooccurs with other neurodevelopmental disorders, including attention deficit hyperactivity disorder, autism spectrum disorder, and learning disabilities. While the etiology of DCD is relatively unknown, neuroimaging studies have confirmed a neural basis to the disorder, showing differences in brain structure and function compared to controls. Possible genetic contributions and environmental exposures are also being investigated as potential causes of DCD. Rehabilitation interventions have shown promise in improving motor skills of children with DCD; however, more comprehensive interventions are needed to address the secondary consequences of the disorder across the lifespan.
DCD is a neurodevelopmental disorder manifesting in difficulties in the motor performance, but also sec-ondarily affects the overall psychosocial development of the given individual. Although the prevalence of DCD is upto 6%, it is an overlooked diagnosis in this country. No tool was available to identify motor deficits until the Czechversion of the MABC-2 Test was published. This test assesses whether the motor performance of a child is below theexpected level, given the chronological age (diagnostic criterion A for DCD). However, within the Czech environmentwe still lack a tool to assess the diagnostic criterion B, the impact of these deficits on the child’s daily living activitiesand academic performance. This purpose can be served by the MABC-2 Checklist, which is originally part of the MABC-2 battery. The aim of this paper is to present a methodological procedure for the adaptation of the MABC-2 Checklistfor DCD diagnostics in the Czech Republic.
Background
The use of information and communication technologies is transforming the lives of millions of people including children with autism spectrum disorder (ASD). However, the process of developing a user-friendly and effective mobile app needs to follow a complex standard protocol and culture-sensitive customization, and involves multiple sectors. This complex work becomes even more challenging when considering children with ASD in low- and middle-income countries as the users.
Objective
This study aimed to design and develop a more intuitive mobile app to improve numeracy skills of children with ASD in Rwanda and evaluate the usability of the app.
Methods
A participatory design approach was utilized in this study in which 40 children with ASD, 5 teachers, and 10 parents of children with ASD participated in focus group discussions (FGDs) and usability testing. A narrative literature review was performed to explore existing mobile apps and compare previous studies to design the questions for FGD and facilitate a framework for designing the app. The agile methodology was used to develop the mobile app, and the heuristics evaluation method was used to test and evaluate the usability of the initial version of the app to improve its functionalities. The interviews were recorded, transcribed, and analyzed following the guidelines of the qualitative narrative analysis (QNA) method.
Results
During the FGDs the respondents shared their need for a mobile app in teaching and learning numeracy for children with ASD and pointed to possibilities of integrating the mobile app into existing curriculum. Ten themes emerged from the FGDs and exercise of developing the mobile app. The themes were related to (1) teaching and learning numeracy for children with ASD, (2) planning and development of a mobile app for a person with ASD, (3) testing a mobile app, (4) strength of the developed app against the existing ones, (5) behavioral maintenance and relapse prevention, (6) possibilities to integrate the mobile app into the existing curriculum, (7) data protection for users, (8) social implications, (9) challenges in Rwanda, and (10) focus on future.
Conclusions
The community plays an important role in the planning, development, and evaluation of a mobile app for children with ASD. In this study, inputs from teachers and parents resulted in an optimally designed mobile app that can improve numeracy skills in children diagnosed with ASD to support the implementation of competency-based curriculum in Rwanda.
Sensory processing and motor coordination atypicalities are not commonly identified as primary characteristics of autism spectrum disorder (ASD), nor are they well captured in the NIMH’s original Research Domain Criteria (RDoC) framework. Here, motor and sensory features performed similarly to RDoC features in support vector classification of 30 ASD youth against 33 typically developing controls. Combining sensory with RDoC features boosted classification performance, achieving a Matthews Correlation Coefficient (MCC) of 0.949 and balanced accuracy (BAcc) of 0.971 ( p = 0.00020, calculated against a permuted null distribution). Sensory features alone successfully classified ASD (MCC = 0.565, BAcc = 0.773, p = 0.0222) against a clinically relevant control group of 26 youth with Developmental Coordination Disorder (DCD) and were in fact required to decode against DCD above chance. These findings highlight the importance of sensory and motor features to the ASD phenotype and their relevance to the RDoC framework.
Children with Autism Spectrum Disorder (ASD), characterized by core deficits in social communication and restrictive behaviors, can exhibit concurrent motor incoordination and/or intellectual disability (ID). While pervasive delays in motor behavior are common, formal diagnosis of Development Coordination Disorder (DCD) is uncommon. It is not clear how DCD and ID impact core deficits in ASD. This study utilized the Simons Foundation SPARK cohort to describe the scope of motor incoordination among children with ASD and examine the interrelationships between DCD risk, ID, and ASD core deficits. 10,234 children with ASD, between the ages of 5 and 15 years, were included in the analysis. Parents completed online versions of the DCD Questionnaire (DCD‐Q), Social Communication Questionnaire (SCQ) and Restrictive Behavior Scale (RBS‐R). 85% of children with ASD had DCD‐Q scores consistent with being at‐risk for DCD, but only 14% reported a formal diagnosis. Children with ID exhibited significantly greater motor incoordination compared to children without ID (P < 0.001). Significantly, greater core deficits were identified in both children at‐risk for DCD (P < 0.001) and with ID (P < 0.001). However, the effects of DCD risk were independent of ID and exhibited a medium effect size for SCQ (η²p = 0.063) and a small effect size for RBS‐R (η²p = 0.04) scores. Collectively, study outcomes reinforce the pervasiveness of motor incoordination among children with ASD, both with and without concurrent ID, and provide further justification for the inclusion of motor behavior in the early intervention and prescription for children with ASD.
Lay Summary
This secondary data analysis of the Simons Foundation SPARK cohort found high rates (85%) of DCD risk among children with ASD. Deficits in motor coordination were greater among children with ASD with concurrent ID diagnoses. Meaningful differences in ASD core deficits (social communication and repetitive behaviors) were independently found in children at risk for DCD, both with and without ID.
Este estudo teve como objetivos principais (i) apresentar valores normativos para os oito subtestes do Teste de Proficiência Motora Bruininks-Oseretsky (BOT-2) e (ii) contrastar com os valores sugeridos no manual do teste original. A amostra foi constituída por 931 crianças com idade entre os seis e 10 anos,de ambos os sexos, provenientes do município de Maringá-PR. Para a avaliação da profi ciência motora foi utilizado o BOT-2. A construção dos valores de referência percentílica foi efetuada com base no método LMS, implementado no software LMSchartmaker Pro versão 2.54. As meninas obtiveram maiores escores nos subtestes precisão motora fina, integração motora fina, destreza manual e equilíbrio. Os meninos apresentaram maiores escores na coordenação de membros superiores, velocidade e agilidade e força muscular. As crianças maringaenses avaliadas apresentaram valores superiores às crianças norte-americanas nos subtestes de coordenação bilateral, velocidade e agilidade, equilíbrio e coordenação dos membros superiores. Os resultados expressam a forte variabilidade interindividual em termos de profi ciência motora, bem como diferenças entre meninos e meninas. As curvas ilustram o aumento dos níveis de proficiência motora ao longo das idades, com trajetórias distintas para cada subteste. Desse modo, a utilização dos valores normativos apresentados neste estudo poderá auxiliar a ação pedagógica nos contextos escolares e esportivos, contribuindo para o planejamento de intervenções motoras mais efetivas.
Purpose
An alliance of schools and researchers formed a collaborative community of practice in order to understand and improve the sensory school environment for pupils on the autistic spectrum, and incorporate the findings into school improvement planning. The paper aims to discuss this issue.
Design/methodology/approach
Representatives of special and mainstream schools in South London and a team of researchers formed the project team, including an autistic researcher. The researchers and a named staff member from each of the schools met regularly over the course of 18 months in order to work on an iterative process to improve the sensory experience pupils had of the school environment. Each school completed sensory audits and observations, and was visited by members of the research team. Parents were involved via meetings with the research team and two conferences were organised to share findings.
Findings
Useful outcomes included: developing and sharing of good practice between schools; opportunities for parents of autistic pupils to discuss their concerns, particularly with someone with insider perspective; and exploration of creative ways to achieve pupil involvement and the idea that good autism practice has the potential to benefit all pupils. A resource pack was produced for the schools to access. Plans are in place to revisit the initiative in 12 months’ time in order to ascertain whether there have been long-term benefits.
Originality/value
Projects building communities of practice involving autistic people as core team members are rare, yet feedback from those involved in the project showed this to be a key aspect of shared learning.
Introduction:
The DCDQ is a parental report designed to assess daily living activities of children, and serves as a useful questionnaire to aid in the diagnostic criteria of Developmental Coordination Disorder (DCD). It is divided into three components: control during movement, fine motor/handwriting, and general coordination. The results categorize children in two groups: “Indication of DCD/suspect DCD”, and “probably not DCD”.
Objective:
The objective of this study was to determine appropriate cut-off scores for the Developmental Coordination Disorder Questionnaire - Brazil (DCDQ-BR) for use with Brazilian children employing a large sample.
Methods:
Seven hundred and seven children ages 6-10 were assessed with the DCDQ-BR and the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). Descriptive statistics was used to characterize the sample, and concurrent validity was assessed using Pearson's Correlation Coefficient. Predictive validity was determined through values of sensitivity (S) and specificity (E), while ROC curves were used to determine the optimal cut-off score for the DCDQ-BR.
Results:
Pearson's correlation coefficient analysis revealed a significant correlation between total scores of the DCDQ-BR and BOT-2 (r= 0.55 (p=0.00). Cut-off scores for the DCDQ-BR based on the BOT-2 17th percentile (relating to below average descriptive category) were established as ≤40, ≤46 and ≤51 for ages 6-7 years and 11 months; 8-9 years and 11 months; and 10-10 years and 11 months, respectively.
Conclusion:
Based on the results of this study and previous literature suggesting the need for a reevaluation of cut-off scores for the Brazilian population with a larger sample, we recommend that the cut-off scores of the DCDQ-BR are adjusted to the values found with our sample. Level of evidence II; Diagnostic studies – Investigating a diagnostic test.
Motor and social difficulties are often found in children with an autism spectrum disorder (ASD) and with developmental coordination disorder (DCD), to varying degrees. This study investigated the extent of overlap of these problems in children aged 7-10 years who had a diagnosis of either ASD or DCD, compared to typically-developing controls. Children completed motor and face processing assessments. Parents completed questionnaires concerning their child's early motor and current motor and social skills. There was considerable overlap between the ASD and DCD groups on the motor and social assessments, with both groups more impaired than controls. Furthermore, motor skill predicted social functioning for both groups. Future research should consider the relationships between core symptoms and their consequences in other domains.
Problem/condition:
Autism spectrum disorder (ASD).
Period covered:
2012.
Description of system:
The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification.
Results:
For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.6 per 1,000 (one in 68) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.6 per 1,000) than among girls aged 8 years (5.3 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.5 per 1,000) compared with non-Hispanic black children (13.2 per 1,000), and Hispanic (10.1 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only health care records were reviewed) to 24.6 per 1,000 children aged 8 years (in New Jersey, where both education and health care records were reviewed). Estimated prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 and 10.7 per 1,000 children aged 8 years, respectively; p<0.05). Among children identified with ASD by the ADDM Network, 82% had a previous ASD diagnosis or educational classification; this did not vary by sex or between non-Hispanic white and non-Hispanic black children. A lower percentage of Hispanic children (78%) had a previous ASD diagnosis or classification compared with non-Hispanic white children (82%) and with non-Hispanic black children (84%). The median age at earliest known comprehensive evaluation was 40 months, and 43% of children had received an earliest known comprehensive evaluation by age 36 months. The percentage of children with an earliest known comprehensive evaluation by age 36 months was similar for boys and girls, but was higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%) and Hispanic children (39%).
Interpretation:
Overall estimated ASD prevalence was 14.6 per 1,000 children aged 8 years in the ADDM Network sites in 2012. The higher estimated prevalence among sites that reviewed both education and health records suggests the role of special education systems in providing comprehensive evaluations and services to children with developmental disabilities. Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children.
Public health action:
The ADDM Network will continue to monitor the prevalence and characteristics of ASD among children aged 8 years living in selected sites across the United States. Recommendations from the ADDM Network include enhancing strategies to 1) lower the age of first evaluation of ASD by community providers in accordance with the Healthy People 2020 goal that children with ASD are evaluated by age 36 months and begin receiving community-based support and services by age 48 months; 2) reduce disparities by race/ethnicity in identified ASD prevalence, the age of first comprehensive evaluation, and presence of a previous ASD diagnosis or classification; and 3) assess the effect on ASD prevalence of the revised ASD diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Dyspraxia is “a developmental condition in which the ability to plan unfamiliar motor tasks is impaired” (Bundy, Lane, & Murray, 2002, p. 477–478). The purpose of this article is to review current views of dyspraxia and its relationship to occupational therapy services for clients with an autism spectrum disorder (ASD). An emerging body of evidence demonstrates the impact of dyspraxia on partici- pation in individuals with an ASD (Dziuk et al., 2007; Roley et al., 2015). First, this article reviews seminal work on praxis and ASDs, followed by consideration of recent findings on the evidence for a neural basis of dyspraxia in ASDs. Next, we will highlight the risks and implications for occupational performance. Finally, we will discuss how this body of evidence informs occupational therapy practice, especially in applying Ayres Sensory Integration® (ASI) for people with an ASD.
Grip selection tasks have been used to test “planning” in both autism and developmental coordination disorder (DCD). We differentiate between motor and executive planning and present a modified motor planning task. Participants grasped a cylinder in 1 of 2 orientations before turning it clockwise or anticlockwise. The rotation resulted in a comfortable final posture at the cost of a harder initial reaching action on 50% of trials. We hypothesized that grip selection would be dominated by motoric developmental status. Adults were always biased towards a comfortable end-state with their dominant hand, but occasionally ended uncomfortably with their nondominant hand. Most 9- to 14-year-olds with and without autism also showed this “end-state comfort” bias but only 50% of 5- to 8-year-olds. In contrast, children with DCD were biased towards selecting the simplest initial movement. Our results are best understood in terms of motor planning, with selection of an easier initial grip resulting from poor reach-to-grasp control rather than an executive planning deficit. The absence of differences between autism and controls may reflect the low demand this particular task places on executive planning.
Despite being largely characterized as a social and cognitive disorder, strong evidence indicates the presence of significant sensory-motor problems in Autism Spectrum Disorder (ASD). This paper outlines our progression from initial, broad assessment using the Movement Assessment Battery for Children (M-ABC2) to subsequent targeted kinematic assessment. In particular, pronounced ASD impairment seen in the broad categories of manual dexterity and ball skills was found to be routed in specific difficulties on isolated tasks, which were translated into focused experimental assessment. Kinematic results from both subsequent studies highlight impaired use of perception-action coupling to guide, adapt and tailor movement to task demands, resulting in inflexible and rigid motor profiles. In particular difficulties with the use of temporal adaption are shown, with "hyperdexterity" witnessed in ballistic movement profiles, often at the cost of spatial accuracy and task performance. By linearly progressing from the use of a standardized assessment tool to targeted kinematic assessment, clear and defined links are drawn between measureable difficulties and underlying sensory-motor assessment. Results are specifically viewed in-light of perception-action coupling and its role in early infant development suggesting that rather than being "secondary" level impairment, sensory-motor problems may be fundamental in the progression of ASD. This logical and systematic process thus allows a further understanding into the potential root of observable motor problems in ASD; a vital step if underlying motor problems are to be considered a fundamental aspect of autism and allow a route of non-invasive preliminary diagnosis.
For decades autism has been defined as a triad of deficits in social interaction, communication, and imaginative play. Though there is now broad acknowledgment of the neurological basis of autism, there is little attention paid to the contribution of such neurological differences to a person's development and functioning. Communication, relationship, and participation require neurological systems to coordinate and synchronize the organization and regulation of sensory information and movement. Developmental differences in these abilities are likely to result in differences in the way a person behaves and expresses intention and meaning. The present paper shares our emerging awareness that people may struggle with difficulties that are not immediately evident to an outsider. This paper explores the symptoms of sensory and movement differences and the possible implications for autistic people. It provides a review of the history and literature that describes the neurological basis for many of the socalled behavioral differences that people experience. The paper emphasizes the importance of our acknowledgment that a social interpretation of differences in behavior, relationship, and communication can lead us far away from the lived experience of individuals with the autism label and those who support them. We suggest alternative ways to address the challenges faced by people with autism.
Students with autism display sensory sensitivities to environmental stimuli that affect their attending and engagement in classroom learning activities. The purpose of the study was to determine whether attending of 4 male students, ages 13-20, increased after the installation of sound-absorbing walls and halogen lighting. The multiple single-subject, mixed-method design, AB(B+C), included a 2-wk baseline and two intervention phases: 2 wk after sound-absorbing wall installation using the Owens Corning Basement Finishing System™ (Owens Corning, Toledo, OH) and 2 wk after halogen light installation. We calculated nonattending frequencies from videotaped class sessions and used visual analysis to measure within-phase and between-phase characteristics. Results included increased frequency and stability of attending and engagement and improved classroom performance, comfort, and mood. Journaling provided students' perspective on the modifications and reflected overall increased sensory comfort and themes of improved classroom environment, positive emotional response (mood), and improved classroom performance.
Physical therapy enables children and adults to develop and optimize their mobility and movement-related functions. The purpose of the physiotherapy treatment is to achieve meaningful participation in areas of life as independently and unaided as possible and with high quality of life. Treatment priorities are based upon information from the child, parent, and school, as well as the professional knowledge of the therapist about motor learning, motor control, and constraints related to the disease and age. The hypothesis-oriented algorithm for clinicians II (HOAC II) is commonly used to guide clinicians when documenting patient care and incorporating evidence into practice.172 It helps to justify interventions for problems that require remediation and those that may occur in the future and that require prevention. Physical therapists are specialized in analysing motor development, movements, and specific activities as well as in determining relevant problems in cases of dysfunctions. Together with the social system of the client, goals will be arranged to cope with the problems. Physical therapists use different approaches depending on child, and family, goal and situation, for example process-oriented approaches like adapted neurodevelopmental therapy, sensory integration, strategic task-oriented approaches like CO-OP, or specific task-oriented interventions like neuromotor task training (NTT) and adaptation of environment. They use tests like M-ABC-2 or BOTMP in their assessments and parent/teacher questionnaires to evaluate the motor development and performance of the children and their needs. Counselling and coaching the parents and class teachers are important in physical therapy.
The study aimed at exploring the effectiveness of cognitive intervention with the new "Instrumental Enrichment Basic" program (IE-basic), based on Feuerstein's theory of structural cognitive modifiability that contends that a child's cognitive functioning can be significantly modified through mediated learning intervention. The IE-basic progam is aimed at enhancing domain-general cognitive functioning in a number of areas (systematic perception, self-regulation abilities, conceptual vocabulary, planning, decoding emotions and social relations) as well as transferring learnt principles to daily life domains. Participants were children with DCD, CP, intellectual impairment of genetic origin, autistic spectrum disorder, ADHD or other learning disorders, with a mental age of 5-7 years, from Canada, Chile, Belgium, Italy and Israel. Children in the experimental groups (N=104) received 27-90 h of the program during 30-45 weeks; the comparison groups (N=72) received general occupational and sensory-motor therapy. Analysis of the pre- to post-test gain scores demonstrated significant (p<0.05) advantage of experimental over comparison groups in three WISC-R subtests ("Similarities", "Picture Completion", "Picture Arrangement") and Raven Coloured Matrices. Effect sizes ranged from 0.3 to 0.52. Results suggest that it is possible to improve cognitive functioning of children with developmental disability. No advantage was found for children with specific aetiology. Greater cognitive gains were demonstrated by children who received the program in an educational context where all teachers were committed to the principles of mediated learning.
The Developmental Coordination Disorder Questionnaire (DCDQ) is a parent-completed measure designed to identify subtle motor problems in children of 8 to 14.6 years of age. The purpose of this study was to extend the lower age range to children aged 5 to 7 years, revise items to ensure clarity, develop new scoring, and evaluate validity of the revised questionnaire. Additional items with improved wording were generated by an expert panel. Analyses of internal consistency, factor loading, and qualitative/quantitative feedback from researchers, clinicians, and parents were used to select 15 items with the strongest psychometric properties. Internal consistency was high (alpha = .94). The expanded questionnaire was completed by the parents of 287 children, aged 5-15 years, who were typically developing. Logistic regression modeling was used to generate separate cutoff scores for three age groups (overall sensitivity = 85%, specificity = 71%). The revised DCDQ was then compared to other standardized measures in a sample of 232 children referred for therapy services. Differences in scores between children with and without DCD (p < .001) provide evidence of construct validity. Correlations between DCDQ scores and Movement Assessment Battery for Children (r = .55) and Test of Visual-Motor Integration (r = .42) scores support concurrent validity. The results provide evidence that the revised DCDQ is a valid clinical screening tool for DCD.
The aim of the present study was to directly compare working memory skills across students with different developmental disorders to investigate whether the uniqueness of their diagnosis would impact memory skills. The authors report findings confirming differential memory profiles on the basis of the following developmental disorders: Specific Language Impairment, Developmental Coordination Disorder (DCD), Attention-Deficit/Hyperactivity Disorder, and Asperger syndrome (AS). Specifically, language impairments were associated with selective deficits in verbal short-term and working memory, whereas motor impairments (DCD) were associated with selective deficits in visuospatial short-term and working memory. Children with attention problems were impaired in working memory in both verbal and visuospatial domains, whereas the children with AS had deficits in verbal short-term memory but not in any other memory component. The implications of these findings are discussed in light of support for learning.
The objective of this study was to examine the efficacy of Interactive Metronome (Interactive Metronome, Sunrise, Florida, USA) training in a group of children with mixed attentional and motor coordination disorders to further explore which subcomponents of attentional control and motor functioning the training influences. Twelve children who had been diagnosed with attention deficit hyperactivity disorder, in conjunction with either developmental coordination disorder (n=10) or pervasive developmental disorder (n=2), underwent 15 1-h sessions of Interactive Metronome training over a 15-week period. Each child was assessed before and after the treatment using measures of attention, coordination, and motor control to determine the efficacy of training on these cognitive and behavioral realms. As a group, the children made significant improvements in complex visual choice reaction time and visuomotor control after the training. There were, however, no significant changes in sustained attention or inhibitory control over inappropriate motor responses after treatment. These results suggest Interactive Metronome training may address deficits in visuomotor control and speed, but appears to have little effect on sustained attention or motor inhibition.
Recent developments in the quantitative analysis of complex networks, based largely on graph theory, have been rapidly translated to studies of brain network organization. The brain's structural and functional systems have features of complex networks--such as small-world topology, highly connected hubs and modularity--both at the whole-brain scale of human neuroimaging and at a cellular scale in non-human animals. In this article, we review studies investigating complex brain networks in diverse experimental modalities (including structural and functional MRI, diffusion tensor imaging, magnetoencephalography and electroencephalography in humans) and provide an accessible introduction to the basic principles of graph theory. We also highlight some of the technical challenges and key questions to be addressed by future developments in this rapidly moving field.
This study investigated the problems of attention, learning and psychosocial adjustment evidenced by children with developmental coordination disorder (DCD). Forty-five children identified with DCD, 51 children identified as being suspect for DCD and 78 comparison children without motor problems on standardized tests of motor function participated in this study. Results revealed that both children with DCD and children suspect for DCD obtained significantly poorer scores on measures of attention and learning (reading, writing and spelling) than comparison children. Children with DCD and those suspect for DCD were also found to evidence a relatively high level of social problems and display a relatively high level of somatic complaints based on parent report. These findings indicate that all children with movement problems are at risk for problems in attention, learning and psychosocial adjustment. Assessment of children with movement problems, regardless of the degree or severity of these problems should examine a wide range of functions in addition to motor functioning. Such an approach, would assist in determining the types of intervention that would provide the most benefit to these children.
Children with Developmental Coordination Disorder (DCD) often have limited participation in social activities, causing isolation, anxiety, emotional and social problems in children themselves and their families. This paper reviews studies that investigated participation in activities of children with DCD in home, community and school. Assessments to evaluate social participation of children with DCD, intervention, strategies and future research considerations for children with DCD are suggested.
Children with developmental coordination disorder (DCD) have difficulty learning and performing age-appropriate perceptual-motor skills in the absence of diagnosable neurological disorders. Descriptive studies have shown that comorbidity of DCD exists with attention-deficit/hyperactivity disorder (ADHD) and learning disabilities (LD). This study examined the consequences of the comorbidity of DCD and LD for the severity and pattern of perceptual-motor dysfunction. Compared to children with DCD without LD, children with comorbid DCD and LD performed lower on a standardized assessment of perceptual-motor ability. Furthermore, it appeared that children with combined DCD and LD have particular difficulty performing manual dexterity and balance tasks but not ball-skill tasks. Implications for understanding the relationship between LD and perceptual-motor problems are discussed. We conclude that the comorbidity of DCD and LD not only affects the severity of perceptual-motor dysfunction but also is associated with a distinctive pattern of perceptual-motor dysfunction.
Over the last decade, there has been an enormous increase in the number of studies evaluating the overlap of developmental syndromes or disorders in both children and adults. This overlap of symptoms is often referred to as comorbidity, a term we criticize in this article because of its unsubstantiated presumption of independent etiologies. The premise of this article is that discrete categories do not exist in real life, and that it is misleading to refer to overlapping categories or symptoms as "comorbidities." We illustrate our point by presenting data from 179 school-age children evaluated with rigorous research criteria for seven disorders: reading disability (RD), attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), oppositional defiant disorder (ODD), conduct disorder (CD), depression, and anxiety. Fully 50% of this sample met the criteria for at least two diagnoses. The children with ADHD were at higher risk of having at least a second disorder compared to the children with RD. Overall, the high rates of overlap of these behavioral, emotional, and educational deficits in this broadly ascertained sample support the idea that the concept of comorbidity is inadequate. We discuss the concept of atypical brain development as an explanatory idea to interpret the high rate of overlap of developmental disorders.
This article focuses on postural anticipation and multi-joint coordination during locomotion in healthy and autistic children. Three questions were addressed. (1) Are gait parameters modified in autistic children? (2) Is equilibrium control affected in autistic children? (3) Is locomotion adjusted to the experimenter-imposed goal? Six healthy children and nine autistic children were instructed to walk to a location (a child-sized playhouse) inside the psychomotor room of the pedopsychiatric centre located approximately 5 m in front of them. A kinematic analysis of gait (ELITE system) indicates that, rather than gait parameters or balance control, the main components affected in autistic children during locomotion are the goal of the action, the orientation towards this goal and the definition of the trajectory due probably to an impairment of movement planning.
Autism represents an unusual pattern of development beginning in the infant and toddler years.
To examine the stability of autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis.
Prospective study of diagnostic classifications from standardized instruments including a parent interview (Autism Diagnostic Interview-Revised [ADI-R]), an observational scale (Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ADOS]), and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team's criterion standard diagnoses.
Three inception cohorts: consecutive referrals for autism assessment to (1) state-funded community autism centers, (2) a private university autism clinic, and (3) case controls with developmental delay from community clinics.
At 2 years of age, 192 autism referrals and 22 developmentally delayed case controls; 172 children seen at 9 years of age.
Consensus best-estimate diagnoses at 9 years of age.
Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67, with a weighted kappa of 0.72. Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism. Each measure at age 2 years was strongly prognostic for autism at age 9 years, with odds ratios of 6.6 for parent interview, 6.8 for observation, and 12.8 for clinical judgment. Once verbal IQ (P = .001) was taken into account at age 2 years, the ADI-R repetitive domain (P = .02) and the ADOS social (P = .05) and repetitive domains (P = .005) significantly predicted autism at age 9 years.
Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified. Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation.
Children with autistic disorder (AD), mixed receptive-expressive language disorder (RELD), or developmental coordination disorder (DCD) have impairments in common. We assess which abilities differentiate the disorders. Children aged 3-13 years diagnosed with AD (n = 30), RELD (n = 30), or DCD (n = 22) were tested on measures of language, intelligence, social cognition, motor coordination, and executive functioning. Results indicate that the AD and DCD groups have poorer fine and gross motor coordination and better response inhibition than the RELD group. The AD and DCD groups differ in fine and gross motor coordination, emotion understanding, and theory of mind scores (AD always lower), but discriminant function analysis yielded a non-significant function and more classification errors for these groups. In terms of ability scores, the AD and DCD groups appear to differ more in severity than in kind.
Motor and gestural skills of children with autism spectrum disorders (ASD), developmental coordination disorder (DCD), and/or attention deficit hyperactivity disorder (ADHD) were investigated. A total of 49 children with ASD, 46 children with DCD, 38 children with DCD+ADHD, 27 children with ADHD, and 78 typically developing control children participated. Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency Short Form, and gestural skills were assessed using a test that required children to produce meaningful gestures to command and imitation. Children with ASD, DCD, and DCD+ADHD were significantly impaired on motor coordination skills; however, only children with ASD showed a generalized impairment in gestural performance. Examination of types of gestural errors revealed that children with ASD made significantly more incorrect action and orientation errors to command, and significantly more orientation and distortion errors to imitation than children with DCD, DCD+ADHD, ADHD, and typically developing control children. These findings suggest that gestural impairments displayed by the children with ASD were not solely attributable to deficits in motor coordination skills.
Children with autism spectrum disorders (ASD) often exhibit motor clumsiness (Developmental Coordination Disorder, DCD), i.e. they struggle with everyday tasks that require motor coordination like dressing, self-care, and participating in sport and leisure activities. Previous studies in these neurodevelopmental disorders have demonstrated functional abnormalities and alterations of white matter microstructural integrity in specific brain regions. These findings suggest that the global organization of brain networks is affected in DCD and ASD and support the hypothesis of a 'dys-connectivity syndrome' from a network perspective. No studies have compared the structural covariance networks between ASD and DCD in order to look for the signature of DCD independent of comorbid autism. Here, we aimed to address the question of whether abnormal connectivity in DCD overlaps that seen in autism or comorbid DCD-autism. Using graph theoretical analysis, we investigated differences in global and regional topological properties of structural brain networks in 53 children: 8 ASD children with DCD (DCD+ASD), 15 ASD children without DCD (ASD), 11 with DCD only, and 19 typically developing (TD) children. We constructed separate structural correlation networks based on cortical thickness derived from Freesurfer. The children were assessed on the Movement-ABC and the Beery Test of Visual Motor Integration. Behavioral results demonstrated that the DCD group and DCD+ASD group scored on average poorer than the TD and ASD groups on various motor measures. Furthermore, although the brain networks of all groups exhibited small-world properties, the topological architecture of the networks was significantly altered in children with ASD compared with DCD and TD. ASD children showed increased normalized path length and higher values of clustering coefficient. Also, paralimbic regions exhibited nodal clustering coefficient alterations in singular disorders. These changes were disorder-specific, and included alterations in clustering coefficient in the isthmus of the right cingulate gyrus and the pars orbitalis of the right inferior frontal gyrus in ASD children, and DCD-related increases in the lateral orbitofrontal cortex. Children meeting criteria for both DCD and ASD exhibited topological changes that were more widespread from those seen in children with only DCD, i.e. children with DCD+ASD showed alterations of clustering coefficient in (para)limbic regions, primary areas, and association areas. The DCD+ASD group showed changes in clustering coefficient in the left association cortex relative to the ASD group. Finally, the DCD+ASD group shared ASD-specific abnormalities in the pars orbitalis of right inferior frontal gyrus, which was hypothesized to reflect atypical emotional-cognitive processing. Our results provide evidence that DCD and ASD are neurodevelopmental disorders with a low degree of overlap in abnormalities in connectivity. The co-occurrence of DCD+ASD was also associated with a distinct topological pattern, highlighting the unique neural signature of comorbid neurodevelopmental disorders.
The present study compared individuals with high-functioning autism (HFA) and Asperger disorder (AD) in intellectual, motor, visuospatial, and executive function domains. Participants with AD demonstrated significantly higher Verbal and Full Scale IQ scores, significantly larger Verbal-Performance IQ discrepancies, and significantly better visual-perceptual skills than those with HFA. Once the superior intellectual abilities of the AD group were controlled (both statistically through analysis of covariance and by examining IQ-matched subgroups of HFA and AD participants), no significant group differences in motor, visuospatial, or executive functions were evident, save a marginally significant trend toward poorer fine motor performance in the AD group. This suggests that AD may simply be "high-IQ autism" and that separate names for the disorders may not be warranted. The relation of these findings to theories of autism and AD are discussed.
A rapidly developing topic in the field of autism spectrum disorders (ASD) is developmental coordination disorder (DCD). Better understanding, identifying, and assessing these problems are important for researchers and clinicians in the ASD field. This chapter defines the problem and covers relevant research exploring the relationship between ASD and DCD.
Children with autistic spectrum disorders (ASDs) and developmental coordination disorder (DCD) are at an increased risk for a range of motor, sensory and social challenges which affect their ability to function at school. The current small scale, qualitative study sought to investigate
how children with ASD and/or DCD felt about the transition to secondary school from primary. Face-to-face, semi-structured interviews were used and the data was analysed thematically. A total of six children (five boys and one girl) in year six (aged 10–11 years) participated. Two main
themes emerged which centred around worries and support strategies. Although they were able to offer suggestions around how they could be supported, worries exceeded their suggested support strategies. A major concern for these children was physical exercise (PE) at secondary school. The current
study has provided a base from which further research can be positioned into how best to support children with ASDs and DCD with the transition from primary to secondary school.
We study the background to problems of functional connectivity in autism spectrum disorders within the neurocognitive framework of the global workspace model. This we proceed to do by observing network irregularities detracting from that of a well-formed small world network architecture. This is discussed in terms of pathologies in functional connectivity and lack of central coherence disrupting inter-network communication thus impairing effective cognitive action. A typical coherence-connectivity measure as a by-product of various neuroimaging results is considered. This is related to a model of feedback control in which a coherence function in the frequency domain is modified by an environmentally determined interaction parameter. With respect to the latter, we discuss the stability question that in theory may counterbalance inessential metabolic costs and incoherence of processing. We suggest that factors such as local overconnectivity and global underconnectivity, along with acute over-expenditure of metabolic costs give rise to instability within the connective core of the workspace.
Background
Motor development allows infants to gain knowledge of the world but its vital role in social development is often ignored. MethodA systematic search for papers investigating the relationship between motor and social skills was conducted, including research in typical development and in Developmental Coordination Disorder, Autism Spectrum Disorders and Specific Language Impairment. ResultsThe search identified 43 studies, many of which highlighted a significant relationship between motor skills and the development of social cognition, language and social interactions. Conclusions
This complex relationship requires more attention from researchers and practitioners, allowing the development of more tailored intervention techniques for those at risk of motor, social and language difficulties.
The article is in response to critiques of the authors' review of the literature on the effectiveness of sensory integration therapy with mentally retarded persons. After responding to the individual criticisms, the authors encourage research into the specific mechanisms functioning to produce effects and how such mechanisms relate to proposed theoretical constructs. (DB)