One paper, One week: when movement tells a hidden story in autism

Autism spectrum disorder (ASD) is widely known for challenges in social interaction, communication, and repetitive behaviours. But another dimension of ASD often receives far less attention: movement.

Across decades of research, clinicians and scientists have observed many children with ASD experience difficulty with motor coordination. Yet motor impairments are not part of the core diagnostic criteria for autism. This raises an important question: are these motor challenges simply associated features of ASD, or they reflect something deeper about how neurodevelopment unfolds?

A recent systematic review set out to examine this question by synthesizing findings from studies investigating motor performance in children with autism.

A hidden pattern across dozens of studies

The review analyzed 27 studies examining motor abilities in children with ASD. Together, these studies reveal a pattern:

Between 50% and 88% of children with ASD show measurable motor impairments on standardized motor assessments or functional performance measures.These deficits appear across a wide range of motor domains. Children with ASD frequently score lower than typically developing peers on widely used motor tests such as:

• Movement Assessment Battery for Children (MABC / MABC-2)

• Test of Gross Motor Development (TGMD)

• Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

Across these tools, a consistent signal emerges: motor coordination difficulties are common rather than exceptional in autism. Yet surprisingly, only a small number of studies explicitly interpret these motor difficulties as developmental coordination disorder (DCD), despite many children meeting diagnostic criteria.

Fine motor skills: the everyday challenges

Fine motor control underlies countless daily tasks that children perform at home and in school. Studies consistently report that children with ASD experience difficulties with:

• manual dexterity

• grip strength

• motor speed

• eye–hand coordination

• fine motor precision

These challenges can affect activities that many people take for granted:

• buttoning a jacket

• cutting food

• handwriting

• using tools

Even subtle impairments in these abilities can influence participation in school activities, independence in self-care, and engagement with peers.

Gross motor skills: coordination in motion

Motor differences also extend to whole-body movement.

Children with ASD frequently demonstrate challenges with:

• running speed and agility

• jumping and locomotor coordination

• throwing, catching, or kicking objects

• balance and postural control

• bilateral coordination

These skills are essential for playgrounds, sports, and social interaction during physical play. When movement becomes more difficult, opportunities for social engagement can shrink.

When motor skills shape daily life

Motor impairments are not simply laboratory observations. They often translate into functional challenges in everyday life. Studies using tools such as the Vineland Adaptive Behaviour Scales and the Developmental Coordination Disorder Questionnaire (DCDQ) show that children with ASD frequently experience difficulties with daily living tasks and functional motor activities.

These difficulties can influence:

• independence in self-care

• classroom participation

• physical activity

• confidence

Over time, motor challenges may also contribute to secondary effects like reduced physical fitness, lower self-esteem, anxiety, and social isolation.

An overlooked diagnosis

Perhaps the most striking finding from the review is the gap between motor impairment and diagnosis.

Even though motor difficulties appear in the majority of children with ASD, only a small fraction receive a formal diagnosis of developmental coordination disorder (DCD). One study reported that while 73% of children with ASD showed functional motor impairment, only 15% had a co-occurring DCD diagnosis. Other research suggests that motor impairments in autistic children are frequently overlooked during clinical evaluation.

This matters because recognizing motor impairment opens the door to targeted interventions.

Why early recognition matters

Motor skills play a critical role in child development. They support independence, learning, and socializing.

Early identification of motor challenges allows clinicians to implement evidence-based interventions that improve coordination, confidence, and daily functioning. Programs such as Cognitive Orientation to Occupational Performance (CO-OP) have shown promise in helping children develop motor problem-solving strategies.

Addressing motor impairments may also support improvements in broader developmental domains, including language, social communication, and behavioural regulation.

A perspective shift

The evidence suggests that motor difficulties are not a minor side note in autism. They represent an important but under-recognized dimension of neurodevelopment.

Recognizing the overlap between ASD and DCD helps clinicians and families better understand the full range of challenges that children with autism experience, and provide the support needed to help them thrive.

Sometimes the most revealing signals are not found in words or behaviours, but in something far more fundamental: how the body moves through the world.

Acknowledgement

This week’s One paper One week deep dive highlights the systematic review examining motor impairments and their relationship to developmental coordination disorder in children with autism spectrum disorder.

The work was conducted by Melika Kangarani‑Farahani, Myrah Anum Malik, and Jill G. Zwicker in the Journal of Autism and Developmental Disorders in 2024: https://pubmed.ncbi.nlm.nih.gov/36949273/

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