Movement Challenges in Autism

By Kim Barthel

Compared with the most common Autistic features of communication and social engagement limitations, and sensory processing and behavioural challenges, the motor system is typically the most neglected aspect in its holistic assessment and intervention. But why aren’t movement challenges in people with Autism Spectrum Disorder more often explored? On the surface these primary impairments of ASD appear to be unrelated to the movement system. Current research in neurobiology, movement science and kinematics are now emphasizing the interconnection between motor function and other domains of concern surrounding the diagnosis. Movement challenges are now being recognized as the earliest detectable signs of neurodiversity and because they can be identified and treated at a very early age, this can potentially improve the trajectory of other prevalent challenges experienced by people with autism and neurodiversity throughout their lifespan. The challenges that supporting the movement system can support include social engagement, regulatory issues, communication, repetitive behaviours, overall anxiety and function in daily life.

If we were to pay more attention to the movement system, where would we begin? As an offering towards the assessment of motor control challenges, we can turn to the clinical reasoning model “Spokes on the Wheel” and look into many factors involved:

We know that challenges with postural stability, motor coordination, manual motor skills, ocular motor skills, motor planning, and motor anticipation are limitations that impact day-to-day function in anyone. We also know that varying neurological structures identified as neurodiverse in autism contribute to the production of movement and motor control. The cerebellum and basal ganglia are examples of two clearly identified brain structures that are frequently differently wired in ASD and contribute tremendously to the production of movement. 

In typically developing individuals, the basal ganglia plays an important role in eye movement, movement coordination, sensory modulation and processing, eye-hand coordination, action chaining, and inhibition of unwanted movements. Many individuals on the spectrum present with movements that do not appear to be in alignment with their intention - like having a body sometimes operating on its own volition. Repetitive body movements, such as rocking or hand flapping which may be purposeful regulatory strategies, may also occur as tic-like movements that are not inhibited or dampened by the nervous system. Additionally, some movements are like “noise” in the sensorimotor feedback loop of action that are difficult to terminate despite the person’s desire to have them stop. Dana Johnson (https://interplaytherapycenter.com/) describes this brain-body disconnect as “Autistic Inertia” or “loops” of extraneous feedback that are not inhibited appropriately within the nervous system. Detective work is necessary to look at actions in context to the environment, task and relationships.

For decades, the cerebellum has been identified as a brain structure highly implicated in the neurodiversity of ASD. The cerebellum relies heavily upon sensory input from the proprioceptors, vestibular system, and visual system to create the backdrop to movement, muscle tone, readiness to move and postural stability. Given that sensory processing challenges are an integral component of ASD, it is inevitable that motor execution limitations will be victim to poorly integrated neural networks. The cerebellum also contributes to calibration of motor precision, timing and sequencing, and overall motor coordination. The cerebellum functions as a comparator, comparing intended movements with the movements that the body has produced. This comparative function relies heavily upon accurate sensory feedback to create precise and coordinated action. Motor memory is stored within the cerebellum itself. The brain must rely upon memory of old movement experiences for motor learning of new skills to emerge. When observing the actions of those on the spectrum, these postural and movement limitations become highlighted as functional impairments.

Somatosensory input also travels up to many areas of the primary sensory cortex where motor plans and motor actions are created. Interconnectivity challenges within and between neural networks in the ASD brain interrupt the registration, integration and organization of these functions resulting in challenges in knowing how to make the body do what is needed for different functions. 

As OTs, PTs and SLPs, once we acknowledge there is a movement challenge in a young child, how do we support it? One of the only ways I know of to thoroughly assess and treat movement is through Neuro-Developmental Treatment (https://www.ndta.org/). While NDT was originally designed by Berta and Karl Bobath in the 1940s to support people with Cerebral Palsy, it’s increasingly understood today that it can support a wide range of people with neurodiversity. I have offered NDT for Autism courses since 2015, and my own learning and training on this topic continues to deepen. Full appreciation of the importance of early intervention of movement challenges to the trajectory of ASD is gaining awareness.

Therapists who aim to holistically support their young clients would be supported in their practice to look beyond behavioural challenges with a deeper consideration of the movement limitations that contribute to the actions that are observed. Research is increasingly reinforcing this statement. There is reason for hope for people with autism and their families – broader holistic assessments and movement interventions like NDT can support their trajectory for function in daily living, and make some things a bit easier so autistic people can focus on their strengths.

For a deeper dive into this topic join our UPCOMING LIVE Online ASD: Neuro-Developmental Treatment for Children with Autism Spectrum Disorder.  

Wednesday, December 8 – Saturday, December 11, 2021; 3-7 pm each day. https://www.kimbarthel.ca/event/2020/12/08/ndt-for-asd-neuro-developmental-treatment-for-children-with-autism-spectrum-disorder

References

Arthur, T., Vine, S., Brosnan, M., & Buckingham, G. (2020). Predictive sensorimotor control in autism. Brain143(10), 3151-3163.

Cavallo, A., Romeo, L., Ansuini, C., Battaglia, F., Nobili, L., Pontil, M., ... & Becchio, C. (2021). Identifying the signature of prospective motor control in children with autism. Scientific reports11(1), 1-8. 

Hudry, K., Chetcuti, L., & Hocking, D. R. (2020). Motor functioning in developmental psychopathology: A review of autism as an example context. Research in Developmental Disabilities105, 103739.

Li, W., & Pozzo‐Miller, L. (2020). Dysfunction of the corticostriatal pathway in autism spectrum disorders. Journal of Neuroscience Research98(11), 2130-2147.

Lidstone, D. E., & Mostofsky, S. H. (2021). Moving toward understanding autism: Visual-motor integration, imitation, and social skill development. Pediatric Neurology, 122, 98-105.

 
 
Kim Barthel