The Relationship between Motor Skills and ASD Symptoms and the Role of Coexisting Intellectual Disability, Sex, and Treatment among Autistic Children Aged 5 to 15 Years Old in the SPARK Cohort
Open AccessBackground: Studies have shown that motor skill deficits are associated with Autism Spectrum Disorder (ASD) symptoms, but there is inconsistent information regarding the types of motor deficits associated with each symptom. In addition, few have examined the interaction between motor impairment and intellectual disability (ID) or sex, or the potential mediating effects of treatments. Children with motor problems are likely to receive treatments like physical therapy (PT), occupational therapy (OT), and early intervention, which could then lead to a reduction in ASD symptoms. This study sought to determine the relationship between different types of motor impairments and three symptoms of ASD among autistic children: 1) social communication, 2) language level, and 3) restricted, repetitive behaviors (RRBs), evaluate whether ID and sex modify the association, and assess whether PT, OT, and early intervention mediate the relationship. Research Design and Methods: The Simons Foundation Powering Autism Research for Knowledge (SPARK) collects several online questionnaires from participants with ASD, including the Developmental Coordination Disorder Questionnaire (DCDQ), Social Communication Questionnaire (SCQ), Repetitive Behaviors Scale-Revised (RBS-R), and language level. As of December 2020, 23,384 children aged 5 to 15 in SPARK had complete questionnaires and were eligible for this analysis. Path analyses were used to examine the relationship between impairments in overall motor skills, fine motor/handwriting, control during movement, and general coordination on the DCDQ and ASD symptoms based on the SCQ, RBS-R, and language level in two separate models. Conditional process analyses were used to test for moderation and mediation. Results: Less impairment in motor skills of all types were associated with fewer social communication problems and RRBs. Fewer impairments in all types of motor skills were also associated with higher language level, except general coordination, which was associated with lower language level. Both sex and ID significantly moderated the relationship between motor impairment and ASD symptoms. The association was strongest among males with ID for all types of motor impairment and language level, and among males without ID for fine motor impairment and RRBs. It was also strongest among individuals without ID for impairments in overall motor skills, fine motor, control during movement and social communication, and among males for overall motor skills, general coordination, control during movement and RRBs. Early intervention partially mediated the association between impairment in overall motor skills and language level. Conclusions: These analyses confirmed that impairments in both fine and gross motor skills on the DCDQ are related to ASD symptoms. While the relationship between motor impairment and ASD was stronger among certain subgroups, it remained significant for most groups. This reinforces the need for all individuals with ASD to receive motor interventions regardless of coexisting diagnoses. Early intervention is a potential mediator, and this should be further explored in longitudinal studies.
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