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A parent of a three-year-old non-verbal autistic child complained: “His speech therapist didn’t teach my boy to talk. She teaches him to throw and catch a ball, to jump, to climb, to draw, to play… She doesn’t have a clue about autism. Autistic children have problems with language and communication – these are the essential features of autism, not running and jumping around the room. It’s waste of time. Please tell her to start teaching him to speak.”
Who is right: the parent or the speech therapist?
Let’s start with some facts:
Yes, it’s true that communication problems are essential features in autism and are necessary for diagnosis. However, they cannot be considered as primary characteristics because all the ‘communication symptoms’ appear later in life. For example, children who were referred to Knobloch and Pasamanick (1975) for displaying ‘abnormal social responsiveness’ in the first year of life did not develop autism, whereas those who showed disturbance of social interaction at the age of two were found to have autism on follow-up. Furthermore, two thirds of mothers of autistic children were not disturbed by their child’s interaction in the first year (Frith, Soares and Wing 1993).
On the other hand, Dr. Phillip Teitelbaum and colleagues research studies (1998, 2004) showed that babies (who would be diagnosed autistic later) had persistent asymmetry of the posture when lying detected as early as 3 months; the atypical sequence and form of righting; and a characteristic cluster of disturbances of movement patterns that can be seen very early in infancy – at the age of 4–6 months, and sometimes even at birth. Besides, in infancy, the movement disorders present in autism are clearest, not yet masked by other mechanisms that have developed to compensate for them. It is possible that they may vary according to the areas of the brain in which developmental delay or damage has occurred. The movement disorders varied from child to child. Disturbances were revealed in the shape of the mouth and in some or all of the milestones of development, including, lying, righting, sitting, crawling, and walking. These findings indicate that abnormalities in movement can be very early indicators of potential autism.
Many recent research studies highlight the important role of motor skills in ASDs, which, though, are not explicit diagnostic criteria, turn out to be a better predictor of an ASD diagnosis than social communication and language assessments. For example, gross motor delay from 5 to 10 months may indicate problems in communication development (LeBarton & Iverson 2016), in expressive language and ASD diagnosis (LeBarton & Landa 2018). Delays in posture development and in fine motor skills can indicate later problems in speech and language development in babies who will be diagnosed with autism (e.g., Bhat et al. 2012).
Nickel and colleagues (2013) hypothesise that a slower development in sitting and standing postures may trigger negative cascading effects in the communicative domain as well. Fine motor ability relates to language in young children with ASD.
So, the disruption to movement is a core feature of autism, providing a potential new computational marker for its early identification (Anzulewicz et al.2016); and motor impairments associated with postural and motor control problems are fundamental aspects of ASD (Xavier et al. 2019). Though movement is unique to each individual, variations in the kinematic patterning of sequential grasping movements genuinely differentiate children with autism from typically developing children, and failure to develop prospective motor control has been proposed to be a core phenotypic marker of ASD (Cavallo et al. 2021). Postural control may drive the development of other domains in infancy and certain measures of postural control at 6 months could predict language and visual reception behaviour at 12 months (Kyvelidou et al. 2021).
Thus, recent research has produced a growing body of evidence showing that motor abnormalities in individuals with ASD are the rule rather than the exception: developmental motor delays during early childhood may be important predictors of ASD and paediatricians and other specialists should consider the possibility of ASD in infants with motor delays or other concerning motor behaviours (Harris 2017; Setoh et al. 2017; Lim et al. 2021).
Research shows that early motor skill interventions improve the motor skill proficiency of children with ASD; moreover, they also have positive ‘secondary benefits’, including improvements with social skills, listening skills, turn-taking skills, and transition skills (Elliott et al. 2021).
Intriguingly, language regression (which occurs in about 25 per cent of children with ASD) is associated with faster early motor development in autistic children. Manelis L. et al. (2020) have found that children with autism and reported language regression start to crawl, talk, and walk at the same age as other typically developing children and significantly earlier than other children with autism. Almost all children with language regression were born close to full term (>35 weeks) and none had a history of hypotonia. Notably, despite their apparently typical early development, children with language regression were diagnosed with more severe symptoms of ASD than children without language regression. On the basis of their findings, Manelis et al. (2020) suggest that children who experienced language regression comprise a distinct subgroup within the autism spectrum.