Autism represents a heterogenous group of neurodevelopmental disabilities characterized by the presence of social communication impairments and focused and repetitive behaviors.1  Motor impairments are also a frequent co-occurring behavioral and neurologic condition in autistic individuals. These motor impairments include delayed motor milestones, atypical gait, poor visual motor coordination, and difficulties with balance and postural control.2,3  Recent large-scale national cohort and database studies have estimated that motor impairments can affect 35% to 87% of autistic individuals across a lifespan.4,5  Furthermore, motor impairments have been posited to be one of the earliest signs of atypical development in autism and can negatively impact the development of social communication, adaptive function, and participation in physical activity.69  Thus, identification of and interventions for motor impairments can improve multiple neurodevelopmental and physical health outcomes. Despite their prevalence and pervasive nature, motor impairments remain under recognized and under screened by clinicians and researchers. One reason for this gap is that motor impairments are listed as an associated condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, with no standardized guidelines on how to evaluate or categorize these impairments. In addition, current standardized motor assessments are not tailored for autistic individuals and intellectual disability and do not capture the heterogenous nature of motor impairments that can be seen in autistic individuals.10,11  There is a need for more objective motor measures that can evaluate autistic individuals across a life span with a range of intellectual abilities. These objective measures can improve our ability to characterize motor impairments in autism which, in turn, can improve: (1) screening guidelines for clinicians, (2) evaluation of outcomes of motor-based interventions, and (3) referral to more targeted motor interventions.

The Autism Intervention and Research Network (AIR-P) neurology node is uniquely positioned to address these gaps in the field. The neurology node aims to (1) use objective quantitative and qualitative motor measurement methods to improve motor phenotyping across the lifespan, (2) evaluate the benefits of motor-based physical activity interventions on motor skills, adaptive functioning, and physical health outcomes, and (3) disseminate evidence-based information to caregivers and clinicians to improve screening of motor impairments and referral to interventions.

Given the AIR-P’s focus on physical health outcomes and well-being, it is also important to elaborate on the second aim of the neurology node, which includes evaluation of the benefits of motor-based physical activity interventions for autistic individuals. Motor impairments can pose a barrier to engagement in physical activity and organized physical activity programs (eg, soccer, dance, tennis, or yoga). It has been reported that only 14% of autistic youth meet the recommended 60 minutes of physical activity a day.12  Decreased levels of physical activity can compound co-occurring medical conditions already prevalent in autism such as obesity, lower bone mineral density, and hyperlipidemia.13  Engagement in organized physical activity also provides opportunities for developing peer relationships.14  Barriers to engagement in sports represent missed opportunities for autistic individuals to benefit from these meaningful social experiences. Additional barriers to inclusion of autistic youth in organized physical activity programs include caregiver reports of lack of awareness and accessibility of these programs and limited training of staff to support autistic individuals.9,12  The AIR-P neurology node will directly address these issues by conducting clinical intervention studies to evaluate the benefits of motor-based physical activity for autistic individuals. The first phase of this work is underway and is focused on evaluating the benefits of an expressive movement-based dance program on motor skills, physical activity level, social communication, quality of life, and adaptive function.15  The goal of this work is to provide evidence-based recommendations to caregivers, clinicians, and community providers on how to refer and support autistic individuals in organized physical activity programs.

The AIR-P neurology node will use a multifaceted approach to address gaps in identification, awareness, and interventions for motor impairments in autism. Specifically, the node will use methods to improve motor phenotyping in autistic individuals, evaluate motor-based interventions, and disseminate this knowledge to the community at large. The data gathered from the neurology node can help inform other nodes and researchers engaged in the AIR-P network and ultimately build the evidence needed to improve the diagnostic and treatment approach for this prevalent co-occurring neurologic and behavioral condition in autism.

Dr Wilson conceptualized and designed the study, drafted the manuscript, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work.

FUNDING: The present research was supported by a grant from the National Institute of Child Health and Human Development (K23HD099275) and by the Health Resources and Services Administration of the US Department of Health and Human Services under the Autism Intervention Research Network on Physical Health (AIR-P), grant UT2MC39440. The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, the Health Resources and Services Administration, Health and Human Services, or the US government. The views in this commentary are the author’s own and do not reflect the views of the National Institutes of Health or the National Institute of Child Health and Human Development. No funding body or source of support had any role in the drafting or decision to publish this article. Funded by the National institutes of Health (NIH).

     
  • AIR-P

    Autism Intervention Research Network on Physical Health

  •  
  • OPA

    organized physical activities

1
American Psychiatric Association
.
Diagnostic and Statistical Manual of Mental Disorders
, 5th ed.
Washington, DC; London, England
:
American Psychiatric Publishing
;
2013
2
Fournier
KA
,
Hass
CJ
,
Naik
SK
,
Lodha
N
,
Cauraugh
JH
.
Motor coordination in autism spectrum disorders: a synthesis and meta-analysis
.
J Autism Dev Disord
.
2010
;
40
(
10
):
1227
1240
3
Bhat
AN
,
Landa
RJ
,
Galloway
JC
.
Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders
.
Phys Ther
.
2011
;
91
(
7
):
1116
1129
4
Licari
MK
,
Alvares
GA
,
Varcin
K
, et al
.
Prevalence of motor difficulties in autism spectrum disorder: analysis of a population-based cohort
.
Autism Res
.
2020
;
13
(
2
):
298
306
5
Bhat
AN
.
Motor impairment increases in children with autism spectrum disorder as a function of social communication, cognitive and functional impairment, repetitive behavior severity, and comorbid diagnoses: a SPARK study report
.
Autism Res
.
2021
;
14
(
1
):
202
219
6
Piaget
J
.
The Origins of Intelligence in Children
.
New York, NY
:
International Universities Press
;
1952
7
Iverson
JM
.
Developing language in a developing body: the relationship between motor development and language development
.
J Child Lang
.
2010
;
37
(
2
):
229
261
8
LeBarton
ES
,
Iverson
JM
.
Associations between gross motor and communicative development in at-risk infants
.
Infant Behav Dev
.
2016
;
44
(
44
):
59
67
9
Howells
K
,
Sivaratnam
C
,
Lindor
E
, et al
.
Can a community-based football program benefit motor ability in children with autism spectrum disorder? A pilot evaluation considering the role of social impairments
.
J Autism Dev Disord
.
2021
;
52
(
1
):
402
413
10
Wilson
RB
,
McCracken
JT
,
Rinehart
NJ
,
Jeste
SS
.
What’s missing in autism spectrum disorder motor assessments?
J Neurodev Disord
.
2018
;
10
(
1
):
33
11
Wilson
RB
,
Enticott
PG
,
Rinehart
NJ
.
Motor development and delay: advances in assessment of motor skills in autism spectrum disorders
.
Curr Opin Neurol
.
2018
;
31
(
2
):
134
139
12
Gehricke
JG
,
Chan
J
,
Farmer
JG
, et al
.
Physical activity rates in children and adolescents with autism spectrum disorder compared to the general population
.
Res Autism Spectr Disord
.
2020
;
70
:
101490
13
Hill
AP
,
Zuckerman
KE
,
Fombonne
E
.
Obesity and autism
.
Pediatrics
.
2015
;
136
(
6
):
1051
1061
14
Rinehart
NJ
,
Jeste
S
,
Wilson
RB
.
Organized physical activity programs: improving motor and non-motor symptoms in neurodevelopmental disorders
.
Dev Med Child Neurol
.
2018
;
60
(
9
):
856
857
15
Wilson
R
.
Dance for children with neurodevelopmental disorders
.

Competing Interests

CONFLICT OF INTEREST DISCLOSURES: Dr Wilson has no conflicts of interest relevant to this article to disclose.