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Draft:Motor differences in autism

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Autistic people may show motor differences in posture, balance, walking, and arm and hand movements. Posture and balance require maintaining body position while controlling the body’s centre of gravity. Walking involves moving from one place to another, while arm and hand movements involve reaching, pointing, carrying, or manipulating objects. For some autistic people, these motor differences can appear in daily tasks such as getting dressed, standing at a sink to brush their teeth, carrying a plate to a table, pointing to something, playing catch, or throwing a ball. Motor differences can also influence speech and participation in activities with other people, affecting communication, social interaction, and overall quality of life.

In a large community-based study, a majority of autistic children and teens were found to be at risk of motor impairment. Reviews of studies also suggest that motor differences are common in autism, have been reported in children and adults, and may be a core feature of autism.

Motor differences have been studied with respect to several systems, including sensory processing, motor planning, predictive control, and motor learning. Differences in these processes can affect how autistic people plan or adjust their actions.

Motor differences can also affect how assessments of cognition, language, and adaptive behavior are interpreted. Many assessment tasks depend on motor function, including speech, writing, and pointing. As such, assessment scores may reflect motor demands instead of the skill being assessed.

Prevalence and presentation

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Motor coordination difficulties have been reported in autistic children, adolescents, and adults.[1] Studies that combine results from multiple studies have found that autistic people, on average, perform differently from non-autistic people on motor tasks involving both whole-body movements and hand skills.[2][3] Autistic children may experience difficulties in both gross and fine motor skills.[4] Reported motor difficulties in autistic children include limb and body coordination, balance, and gait.[2] Motor differences can affect everyday activities such as dressing, personal hygiene, play, and physical activity.[5][6]

The SPARK study analyzed 11,814 parent-reported questionnaires and found that motor differences were common among autistic participants between the ages of 5 and 15.[3] In this study, most autistic participants were identified as being at risk of developmental coordination disorder (DCD).[3] A meta-analysis also found that motor differences were common across studies of autistic children, suggesting that these differences were not limited to the SPARK sample.[1][2] The presentation of motor differences is also heterogeneous, indicating the importance of careful assessment across different motor domains.[7]

These findings have led some researchers to ask whether motor differences should be understood as a core feature of autism rather than only as a condition that frequently co-occurs with autism.[7]

Developmental trajectories

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Studies of infants and toddlers have described motor differences in timing, posture, walking, and object use among children later identified as autistic or already diagnosed with autism.[4][8] Reviews of motor differences in children suggest that these differences may be observable before or alongside more commonly recognized social-communication differences.[8]

Although often described in young children, motor differences in autism have also been reported in adolescents and adults.[1][7] Reported motor difficulties include problems with coordination, gait, and postural stability.[1] Studies have reported differences in movement preparation and motor planning among autistic people.[9][10] Greater variability in the timing and spatial execution of movements has also been reported.[10]

Studies involving participants described as having “Asperger’s syndrome” or “high-functioning autism” found differences in coordination, gestures, movement patterns, and motor planning among participants without intellectual disability.[9][11]

Studies have also reported that motor skills are related to adaptive behavior, which can affect areas of daily life such as communication, self-care, following routines, and social interaction.[5][6]

Sensorimotor control

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Research has explored how autistic movement may differ in sensory weighting, motor planning, error correction during movement, and adaptation to changing task demands.[10][12][13] Collectively, these areas study how sensory input is integrated during action and how motor output is updated over time.[10][12] For example, when reaching for a cup, a person uses vision and body-position feedback to guide their hand and adjusts the movement until they grasp the cup.

Some studies have suggested that autistic people may use body-position feedback and visual information differently when controlling movement.[13][14][15] One study reported that autistic participants had differences in how the brain expects movement to work, referred to as internal models of action.[14] The authors found that autistic children relied more strongly on proprioceptive feedback during motor learning.[14] For example, when reaching for an object, proprioceptive feedback helps a person sense where the arm and hand are and adjust the movement while it is happening. Standardized neuropsychological testing also found that autistic participants performed similarly to non-autistic controls on simple grip-strength tasks but more slowly on finger-tapping and grooved pegboard tasks, suggesting that movement differences become more apparent as motor tasks require greater sensorimotor integration and coordination.[16]

In discussing cerebellar contributions to motor control in autism, the authors describe a forward-control model in which the motor cortex generates a movement command and sends a copy of it to the cerebellum.[17] The cerebellum uses this copy to predict the movement's sensory effects, compares those predictions with actual sensory feedback, and generates corrections that refine the ongoing movement.[17]

In a feeding study, typically developing children showed muscle activity when preparing to open their mouths before picking up the food.[18] Autistic children showed this muscle preparation later, as the food was being brought to their mouths.

Researchers increasingly consider motor function important for understanding autistic behavior, development, and support needs.[7][19]

Kinesthetic priors and motor learning

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Kinesthetic priors are learned expectations formed from past movement experience.[20] As these expectations become more stable, earlier movements may provide a more reliable guide for later movements.[20] Proprioceptive feedback from the muscles and joints can also influence how movements are learned and adjusted.[13][14] For example, when reaching to point to an object, a person uses past movement experience to estimate how far the arm should move and uses feedback from the arm and hand to adjust the force applied by the index finger. Movement measures such as velocity, distance, and time can therefore provide an objective way to study movement differences.[20] Understanding how these movements vary among autistic people may help explain differences in how they learn from prior movements.

Using trial-to-trial, time-ordered movement data, such as peak velocity, provides a way to study whether past movements influence later movements.[20] Researchers estimated an individualized probability distribution from each participant's movement data using the two-parameter gamma family.[20] The fitted distributions ranged from the exponential limit toward the Gaussian limit.[20] The movements of typically developing participants were more often described by distributions closer to the Gaussian limit. In contrast, the distributions fitted to autistic participants' movements were more often positioned closer to the exponential limit or in intermediate regions of the gamma family, suggesting differences in how prior movement experience informs later movement.[20]

The resulting shape and scale parameters were plotted in a Gamma plane to characterize each participant’s stochastic movement signature and to examine how that signature changed across task conditions and over time.[20] Using this method, distributions closer to the exponential limit of the Gamma family were interpreted as more memoryless.[20] This means that current movements provided less information about how future movements would unfold. By contrast, distributions closer to the Gaussian limit were interpreted as more stable, reliable, and predictive.[20]

Diagram of goal-directed forward movement comparing the variability between typically developing and autism spectrum disorder participants
Gamma distributions were recreated from the forward-movement shape and scale parameters reported by Torres et al. (2013, Table A4). TD refers to typically developing participants; ASD refers to participants with Autism Spectrum Disorder Participants.

Applying this approach to hand-movement data, many autistic participants showed movement patterns closer to the exponential end of the Gamma family than age-matched non-autistic participants.[20] The authors interpreted these findings as consistent with differences in how movement-related sensory feedback and prediction were regulated among the autistic participants studied. Here, movement differences were interpreted as differences in motor control, not as evidence that participants did not understand or intend to cooperate, reach, point, or act upon a task.[20]

These findings may help explain why intentional movements can be harder to control.[10][12][20] If feedback from the body changes from one movement to the next, it may be harder to use past movements to guide the next movement. As a result, movements may need more frequent corrections while they are being carried out.[10][12][20] This framework presents a statistical method for measuring movement differences and linking those results to motor learning and motor control in autism.

Other motor-control research supports the same general idea: autistic motor differences may involve how feedback is used to plan, correct, and learn movements.[10][12] A review and related research suggest that motor differences in autism may involve how sensory information is used to plan and guide movement, especially when that information is more variable.[10][12] In one motor-learning study, autistic children appeared to rely more on the connection between the movements they made and the feedback they received from their muscles and joints.[14] Another study found that autistic children responded more strongly to errors in body-position feedback and less strongly to errors in visual feedback.[13] This suggests they may rely more on body-position feedback than on visual feedback when learning and adjusting movements.[14][21]

Torres’s findings on movement variability are consistent with other studies of motor learning in autism.[13][14] These studies have examined related issues, including how autistic people use body-position feedback, plan movement, predict how an action should feel, and adjust across movements. A key difference is that Torres et al. applied statistical models to time-ordered movement data, using distribution patterns to describe how prior movements informed later movements. To better track motor differences over time, a 2025 article proposed using wearable sensors and AI-supported analysis to quantify motor behavior in autism.[19]

Impact on cognitive assessment

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Motor differences may affect how autistic people perform on some timed cognitive assessments.[21] Assessments that require speech, pointing, writing, or quick responses may not reflect the abilities of people with speech and motor difficulties.[21] [22] One study from 2022 found that autistic children and adolescents with typical IQ scores had lower adaptive behavior scores.[5] The research team suggested that motor differences may help explain this gap.[5] On some processing-speed tests, motor demands may affect how autistic children perform, so their scores may not reflect information-processing ability alone.[21] For people with severe speech or motor impairments, the way an answer must be given may also affect how well a test captures their cognitive or language abilities.[22]

In an Australian study, autistic children recruited from specialist schools in metropolitan Melbourne, Australia, and assigned to a puzzle form of Raven's Coloured Progressive Matrices scored higher than those assigned to the standard book form.[23] The authors suggested that the puzzle version reduced distractions and better engaged sensory-motor attention by allowing participants to grasp and place puzzle pieces.[23] Another research team reported that autistic children performed better on strength-informed and motor-reduced perceptual tasks than on standard school-based assessments, pointing out that cognitive abilities may be underestimated when assessment formats are difficult for the child.[24] Limited speech can make receptive language difficult to assess in autistic people, and researchers recommend using multiple assessment methods, including approaches that allow responses without speech.[22][25] Assessment results should take into account the speech and motor skills needed to respond, because these demands may cause a person's cognitive abilities to be underestimated.[21][22][24]

References

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  1. 1 2 3 4 Fournier, Kimberly A.; Hass, Chris J.; Naik, Sagar K.; Lodha, Neha; Cauraugh, James H. (October 2010). "Motor Coordination in Autism Spectrum Disorders: A Synthesis and Meta-Analysis". Journal of Autism and Developmental Disorders. 40 (10): 1227–1240. doi:10.1007/s10803-010-0981-3. ISSN 0162-3257. PMID 20195737.
  2. 1 2 3 Kangarani-Farahani, M.; Malik, M. A.; Zwicker, J. G. (2024). “Motor Impairments in Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.” Journal of Autism and Developmental Disorders, 54, 1977–1997. https://doi.org/10.1007/s10803-023-05948-1
  3. 1 2 3 Bhat, Anjana Narayan. (2020). “Is Motor Impairment in Autism Spectrum Disorder Distinct From Developmental Coordination Disorder? A Report From the SPARK Study.” Physical Therapy, 100(4), 633–644. https://doi.org/10.1093/ptj/pzz190
  4. 1 2 Lloyd, Meghann; MacDonald, Megan; Lord, Catherine (2013). "Motor skills of toddlers with autism spectrum disorders". Autism. 17 (2): 133–146. doi:10.1177/1362361311402230. PMC 3188325. PMID 21610184.
  5. 1 2 3 4 Fears, N. E., Palmer, S. A., & Miller, H. L. (2022). Motor skills predict adaptive behavior in autistic children and adolescents. Autism Research, 15(6), 1083–1089. https://doi.org/10.1002/aur.2708
  6. 1 2 Bremer, Emily; Cairney, John (2018). "The Interrelationship Between Motor Coordination and Adaptive Behavior in Children with Autism Spectrum Disorder". Frontiers in Psychology. 9 2350. doi:10.3389/fpsyg.2018.02350. PMC 6277471. PMID 30538659.
  7. 1 2 3 4 Miller, Haylie L.; Licari, Melissa K.; Bhat, Anjana; Aziz-Zadeh, Lisa S.; Van Damme, Tine; Fears, Nicholas E.; Cermak, Sharon A.; Tamplain, Priscila M. (2024). “Motor Problems in Autism: Co-Occurrence or Feature?” Developmental Medicine & Child Neurology, 66(1), 16–22. https://doi.org/10.1111/dmcn.15674
  8. 1 2 Posar, Annio; Visconti, Paola.(2022). “Early Motor Signs in Autism Spectrum Disorder.” Children, 9(2), 294. https://doi.org/10.3390/children9020294
  9. 1 2 Rinehart, N. J.; Bellgrove, M. A.; Tonge, B. J.; Brereton, A. V.; Howells-Rankin, D.; Bradshaw, J. L. (2006). “An Examination of Movement Kinematics in Young People with High-Functioning Autism and Asperger’s Disorder: Further Evidence for a Motor Planning Deficit.” Journal of Autism and Developmental Disorders, 36, 757–767. https://doi.org/10.1007/s10803-006-0118-x
  10. 1 2 3 4 5 6 7 8 Gowen, Emma; Hamilton, Antonia (2013). "Motor abilities in autism: A review using a computational context". Journal of Autism and Developmental Disorders. 43 (2): 323–344. doi:10.1007/s10803-012-1574-0. PMID 22723127.
  11. ↑ Green, D.; Baird, G.; Barnett, A. L.; Henderson, L.; Huber, J.; Henderson, S. E. (2002). “The Severity and Nature of Motor Impairment in Asperger’s Syndrome: A Comparison with Specific Developmental Disorder of Motor Function.” Journal of Child Psychology and Psychiatry, 43(5), 655–668. https://doi.org/10.1111/1469-7610.00054
  12. 1 2 3 4 5 6 Whyatt, Caroline; Craig, Cathy (2013). "Sensory-motor problems in Autism". Frontiers in Integrative Neuroscience. 7: 51. doi:10.3389/fnint.2013.00051. PMC 3714545. PMID 23882194.
  13. 1 2 3 4 5 Marko, Mollie K.; Crocetti, Deana; Hulst, Thomas; Donchin, Opher; Shadmehr, Reza; Mostofsky, Stewart H. (2015). "Behavioural and neural basis of anomalous motor learning in children with autism". Brain. 138 (3): 784–797. doi:10.1093/brain/awu394. PMC 4339776. PMID 25609685.
  14. 1 2 3 4 5 6 7 Haswell, Courtney C.; Izawa, Jun; Dowell, Lauren R.; Mostofsky, Stewart H.; Shadmehr, Reza (2009). "Representation of internal models of action in the autistic brain". Nature Neuroscience. 12 (8): 970–972. doi:10.1038/nn.2356. PMC 2740616. PMID 19578379.
  15. ↑ Hannant, Penny; Cassidy, Sarah; Van de Weyer, Rosaline; Mooncey, Sophia. (2018). “Sensory and Motor Differences in Autism Spectrum Conditions and Developmental Coordination Disorder in Children: A Cross-Syndrome Study.” Human Movement Science, 58, 108–118. https://doi.org/10.1016/j.humov.2018.01.010
  16. ↑ Duffield, T. C., Trontel, H. G., Bigler, E. D., Froehlich, A., Prigge, M. B., Travers, B., … Lainhart, J. (2013). Neuropsychological investigation of motor impairments in autism. Journal of Clinical and Experimental Neuropsychology, 35(8), 867–881. https://doi.org/10.1080/13803395.2013.827156
  17. 1 2 Mosconi, Matthew W.; Wang, Zheng; Schmitt, Lauren M.; Tsai, Peter; Sweeney, John A. (2015). “The Role of Cerebellar Circuitry Alterations in the Pathophysiology of Autism Spectrum Disorders.” Frontiers in Neuroscience, 9, 296. https://doi.org/10.3389/fnins.2015.00296
  18. ↑ Cattaneo, Luigi; Fabbri-Destro, Maddalena; Boria, Sonia; Pieraccini, Cinzia; Monti, Annalisa; Cossu, Giuseppe; Rizzolatti, Giacomo. (2007). “Impairment of Action Chains in Autism and Its Possible Role in Intention Understanding.” Proceedings of the National Academy of Sciences, 104(45), 17825–17830. https://doi.org/10.1073/pnas.0706273104
  19. 1 2 Good, Ashley Priscilla; Horn, Elizabeth (2025). "Unlocking autism's complexity: the Move Initiative's path to comprehensive motor function analysis". Frontiers in Integrative Neuroscience. 18 1496165. doi:10.3389/fnint.2024.1496165.
  20. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Torres, Elizabeth B.; Brincker, Maria; Isenhower, Robert W.; Yanovich, Polina; Stigler, Kimberly A.; Nurnberger, John I.; Metaxas, Dimitris N.; José, Jorge V. (2013). “Autism: The Micro-Movement Perspective.” Frontiers in Integrative Neuroscience, 7, 32. https://doi.org/10.3389/fnint.2013.00032
  21. 1 2 3 4 5 Kenworthy, L.; Yerys, B. E.; Weinblatt, R.; Abrams, D. N.; Wallace, G. L. (2013). “Motor Demands Impact Speed of Information Processing in Autism Spectrum Disorders.” Neuropsychology, 27(5), 529–536. https://doi.org/10.1037/a0033599
  22. 1 2 3 4 Stadskleiv, K.; Latham, K.; Spanne, K. T.; Sætre, K.; Fraas, A.; Ruscito, I.; Taha, Y.; Murray, J. (2026). “Assessment of Cognition and Language Using Alternative Response Modalities.” Assessment, 33(1), 46–58. https://doi.org/10.1177/10731911251315012
  23. 1 2 Bello, K. D., Goharpey, N., Crewther, S. G., & Crewther, D. P. (2008). A puzzle form of a non-verbal intelligence test gives significantly higher performance measures in children with severe intellectual disability. BMC Pediatrics, 8, 30. https://doi.org/10.1186/1471-2431-8-30
  24. 1 2 Courchesne, Valérie; Meilleur, Andrée-Anne S.; Poulin-Lord, Marie-Pier; Dawson, Michelle; Soulières, Isabelle. (2015). “Autistic Children at Risk of Being Underestimated: School-Based Pilot Study of a Strength-Informed Assessment.” Molecular Autism, 6, 12. https://doi.org/10.1186/s13229-015-0006-3
  25. ↑ Kasari, C., Brady, N., Lord, C. and Tager-Flusberg, H. (2013), Assessing minimally verbal ASD. Autism Res, 6: 479-493. https://doi.org/10.1002/aur.1334

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