Do children with autism spectrum disorders have motor learning difficulties?
Introduction
Children with autism spectrum disorders (ASD) are characterized as having limitations in social interactions and communication, as well as restricted interests and stereotyped or repetitive behavior patterns (APA, 2013). Although clumsiness and delays of fundamental motor skills are commonly observed among individuals with ASD, motor disturbance is not traditionally considered to be one of the core deficits of ASD (Downey & Rapport, 2012). Recently, however, motor impairment has been identified as a fundamental deficit that contributes to the core symptoms of ASD (Bhat, Landa, & Galloway, 2011; Cossu et al., 2012), and insufficient ability to acquire fundamental motor skills has been proposed as the core for the motor dysfunctions in ASD (Gidley Larson, Bastian, Donchin, Shadmehr, & Mostofsky, 2008). It is estimated that the prevalence of Autistic Disorder [based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) diagnostic criteria] is around 0.1–0.2%, and Pervasive Developmental Disorder (PDD, based on DSM-IV-TR dianostic criteria) is around 0.51–0.76% (Chakrabarti & Fombonne, 2001; Chakrabarti, Haubus, Dugmore, Orgill, & Devine, 2005). It is estimated that 21–100% of children with ASD display a number of different motor deficits (Green et al., 2009; Pan, 2009), suggesting that motor impairment is a significant but under-estimated deficit among individuals with ASD.
Based on the most current version of Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; APA, 2013), there are two core areas of impairment in ASD: “social interactions/communications” and “restrictive, repetitive patterns of behaviors, interests, and activities.” Although this new diagnostic system may provide a better overall description of the disorder, one main concern raised by both clinicians and researchers is that it does not highlight the importance of motor difficulties among the ASD population. Studies suggest that individuals with ASD not only experience motor coordination difficulties, they also show delays in various aspects of motor development at an early age (e.g., David, Baranek, Wiesen, Miao, & Thorpe, 2012). While DSM-IV-TR (American Psychiatric Association, 2000) suggested that Asperger’s disorder, but not Autism, is associated with motor clumsiness, current evidence reveals that both clinical groups are uncoordinated and exhibit motor deficits (e.g., Jansiewicz et al., 2006). A recent study even suggests that motor difficulties should be considered a “cardinal feature” of ASD (Fournier, Hass, Naik, Lodha, & Cauraugh, 2010). In DSM-5 and earlier DSM-IV-TR criteria, however, minimal description of motor impairment has been addressed. The absence of motor impairment criteria and the lack of awareness on motor deficits may prohibit appropriate diagnosis and intervention.
Thus, in this review, we focus on the “motor” aspect of ASD, especially the ability to acquire motor skills (i.e., motor learning). The purpose of this review is to present a synopsis of the current literature on the motor deficits in ASD and their relationships with social communication and behavioral issues, address a possible hypothesis implicating the role of implicit motor learning, and suggest directions for future research and intervention strategies.
Section snippets
Motor dysfunctions—another core feature of ASD
Since Kanner (1943) and Asperger (1991) proposed the descriptions of ASD, motor dysfunction of individuals with ASD has focused on stereotyped and repetitive movements, such as hand flapping or body rocking (American Psychiatric Association, 2000). Although stereotyped and repetitive motor behavior is the diagnostic criterion for ASD, parents and mental health providers have often described a wide range of motor problems, such as delays of motor milestones in early development and appearance of
Motor dysfunctions and core symptoms of ASD
Significant motor difficulties reported in ASD are closely related to a range of abnormal functions that critically contribute to core symptoms of ASD, including social communication and restricted interests, activities and behaviors (Dziuk et al., 2007). For example, akinesia/dyskinesia affect a person’s ability to initiate, switch, efficiently perform, or continue any action, including those involved in communicating, interacting socially, or performing functional activities (Bhat et al., 2011
Motor learning in children with ASD
With the increased awareness and the importance of motor dysfunction in ASD, it is crucial to address possible factors that contribute to these problems. It has been proposed that the impaired performance of certain movements is due to a fundamental problem with motor learning, defined as relatively permanent behavioral changes associated with practice or experience (Schmidt, Sherwood, & Walter, 1988). In clinical practice, children with ASD often show delayed learning of novel motor skills
Implicit learning hypothesis?
Implicit learning is described as the acquisition of knowledge without intention or awareness (for reviews see: Reber, 1993, Shanks and Berry, 2012). It is thought to be one important mechanism for acquiring social, communicative, and motor skills (e.g., Kaufman, DeYoung, Gray, Brown, & Mackintosh, 2009; Meltzoff, Kuhl, Movellan, & Sejnowski, 2009; Perruchet & Desaulty, 2008), raising the possibility that social, communicative, and motor impairments in ASD may arise, in part, from a general
Discussion
Converging evidence suggests that motor impairment should be considered as a fundamental deficit that closely relates to core symptoms of ASD (e.g., Larson & Mostofsky, 2008). Impaired ability to acquire fundamental motor skills may be the core reason for motor dysfunctions in ASD (e.g., Larson, Bastian, Donchin, Shadmehr, & Mostofsky, 2008). Although the research findings on motor learning are quite controversial, studies from the social and language perspectives suggest several important
Conclusion
Although social and communication impairments and repetitive behavioral deficits are the key features of ASD (Downey & Rapport, 2012), more recent studies suggest that motor deficits should also be considered to be among the core symptoms of ASD (Bhat et al., 2011; Cossu et al., 2012). Compromised motor skill acquisition may play a critical role in poor motor performance in this population (Larson & Mostofsky, 2008). However, findings from the motor learning literature are quite inconsistent
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