DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY
ORIGINAL ARTICLE
Impairment in movement skills of children with autistic spectrum disorders | TONY CHARMAN PHD 2 | ANDREW PICKLES PHD 3 | SUSIE CHANDLER PHD 2 | TOM LOUCAS PHD 4 | EMILY SIMONOFF FRCPSYCH 5 | GILLIAN BAIRD FRCPCH 1 DIDO GREEN
PHD
1
1 Guy's & St Thomas' NHS Foundation Trust, London, UK. 2 University College London Institute of Child Health, London, UK. 3 Biostatistics Group, Division of Epidemiology & Health Sciences, University of Manchester, Manchester, UK. 4 School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. 5 Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London, UK. Correspondence to Dr Dido Green at Newcomen Centre, Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK. E-mail:
[email protected]
PUBLICATION DATA
Accepted for publication 20th October 2008. Published online 3rd February 2009. LIST OF ABBREVIATIONS
ASD Autistic spectrum disorders AUC Area under the curve DCDQ Developmental Coordination Disorder Questionnaire M-ABC Movement Assessment Battery for Children SNAP Special Needs and Autism Project ACKNOWLEDGEMENTS
We are grateful to the children and families who participated in the study and to the clinical teams in South Thames, whose collaboration made the study possible. We thank Iris Carcani-Rathwell, Caron Coleman, Rachael Fallows, Greg Pasco, David Meldrum, Amarlie Ousdine, Samantha Ross, Emma Rowley, Vicky Slonims and Martha Turner for their help with assessments. The study was funded by the Wellcome Trust and the Department of Health.
AIM We undertook this study to explore the degree of impairment in movement skills in children with autistic spectrum disorders (ASD) and a wide IQ range. METHOD Movement skills were measured using the Movement Assessment Battery for Children (M-ABC) in a large, well defined, population-derived group of children (n=101: 89 males,12 females; mean age 11y 4mo, SD 10mo; range 10y–14y 3mo) with childhood autism and broader ASD and a wide range of IQ scores. Additionally, we tested whether a parent-completed questionnaire, the Developmental Coordination Disorder Questionnaire (DCDQ), was useful in identifying children who met criteria for movement impairments after assessment (n=97 with complete M-ABCs and DCDQs). RESULTS Of the children with ASD, 79% had definite movement impairments on the M-ABC; a further 10% had borderline problems. Children with childhood autism were more impaired than children with broader ASD, and children with an IQ less than 70 were more impaired than those with IQ more than 70. This is consistent with the view that movement impairments may arise from a more severe neurological impairment that also contributes to intellectual disability and more severe autism. Movement impairment was not associated with everyday adaptive behaviour once the effect of IQ was controlled for. The DCDQ performed moderately well as a screen for possible motor difficulties. INTERPRETATION Movement impairments are common in children with ASD. Systematic assessment of movement abilities should be considered a routine investigation.
Many empirical studies over the past 2 decades have confirmed that movement impairment is common in children with autistic spectrum disorders (ASD). Manjiviona and Prior1 found that 50% of children with Asperger syndrome and 67% of children with autism had a movement impairment on the Henderson Test of Motor Impairment.2 Ghaziuddin and Butler3 found that movement problems were common in children with Asperger syndrome, autism, or pervasive development disorder not otherwise specified, using the Bruininks–Oseretsky Test of Motor Proficiency.4
Miyahara et al.5 reported that 22 of 26 children with Asperger syndrome were at least 2SD below the mean of the Movement Assessment Battery for Children (M-ABC).6 Dewey et al.7 found that 59% of children with ASD met criteria for a movement impairment on the Bruininks– Oseretsky Test of Motor Proficiency (short form).4 Jansiewicz and colleagues8 explored basic motor actions (e.g. repetitive timed hand and feet actions) and ‘soft’ neurological signs (e.g. postures while walking on the outsides of the feet) in males with ASD. They found impairment in ª The Authors. Journal compilation ª Mac Keith Press 2008 DOI: 10.1111/j.1469-8749.2008.03242.x 311
balance and gait, slower speed of timed movements, and greater ‘overflow’ movements in the children with ASD, than in the controls.8 That research group has also suggested an additional praxis (gesture ⁄ imitation) problem in ASD.9 The movement impairments in ASD have been shown to have more similarities to than differences from those found in developmental coordination disorder, where praxis impairment is also suggested, except in the area of ball skills (throwing and catching), where children with ASD show greater impairment.10 Although movement impairments have been frequently identified in samples of children with ASD, the applicability of these findings to the broader ASD population remains to be established. Many studies have been conducted with children with average or close to average IQ, often with a view to contrasting the performance of children with Asperger syndrome and ‘high-functioning’ autism.1,3,5,7–9 Movement impairment is known to be more common in children with intellectual disability (IQ
