Limited motor skills in early infancy may be trait of autism

"Among the infants with familial history of ASD, many were shown to have reduced fine motor skills regardless of eventual ASD diagnosis," says Dr. Rebecca Landa, lead author and director of Kennedy Krieger's Center for Autism and Related Disorders. "This means that reduced fine motor skills could be an ASD endophenotype without predicting full diagnosis. Identifying potential endophenotypes has important implications for future research and may improve our understanding of the neurobiology and genetics of ASDs."

Researchers conducted two experiments examining the correlation of early motor development and object exploration in children with low risk (LR) or high risk (HR) of developing an ASD. Researchers measured key early learning skills, such as object manipulation and grasping activity, in infants at six months of age and again at 10 months. While all infants scored within the expected range and showed no difference in terms of their object manipulation, there were subtle signs that showed reduced grasping activity in HR infants as compared to their LR age-peers. These findings demonstrate that regardless of developmental outcomes, early motor skill differences in HR infants may represent an endophenotype that can be linked to ASD.

About Experiment 1

In experiment 1, participants included 129 infants, largely consisting of infant siblings of children with confirmed ASD diagnoses. During the testing period, most participants were six months old and were then followed longitudinally to the age of 36 months. Infants completed an assessment using the Mullen Scales of Early Learning (MSEL), which is a standardized assessment tool providing scores in five categories: Gross Motor (GM); Fine Motor (FM); Visual Reception (VR); Receptive Language (RL); and Expressive Language (EL). Based on the results of this assessment, infants were then divided into four groups : low-risk (LR) infants without ASD; high-risk (HR) infants without ASD, language, or social delays; HR infants showing language or social delays but not ASD; and HR infants with autism or ASD diagnosis. All children in the HR ASD group met DSM-IV diagnostic criteria for the disorder.

All four groups in Experiment 1 scored within the typical range on the MSEL subtests, meaning that none exhibited a clinical delay in their overall fine motor development at age six months. Subtle differences between HR and LR infants emerged even in HR infants who did not receive a diagnosis of ASD or other delays by age 36 months, which suggests that lower fine motor scores on the MSEL are characteristic of infants at high familial risk for ASD. In order to examine whether the HR infants would catch up to the LR infants in time, researchers conducted a second experiment with new participants.

About Experiment 2

Experiment 2 focused on a new group of six-month-old infants in both LR and HR categories and examined only their grasping behaviors in a naturalistic, free-play context, which was an important factor that emerged in Experiment 1. Participants included 42 infants who were siblings of children with ASD. The infants were observed in an unstructured play session.

The results of Experiment 2 showed reduced grasping and object exploration activity in six-month-old infants at HR for ASD. Overall, the MSEL FM T-score results observed in Experiment 2 show a similar pattern as in Experiment 1, but statistical results are somewhat weakened by an effect of gender in the LR sample. Unique to Experiment 2, was the sole focus on object manipulation-related items of the MSEL, which offered a consistent measure to identify differences between HR and LR infants. Reduced grasping activity in HR infants at age 6 months was also observed during an unstructured free-play task in Experiment 2, which provides additional evidence for the findings observed in Experiment 1. However, the HR infants caught up to the LR group in grasping, as measured in this study, by 10 months of age.

Future studies are needed to examine these preliminary findings more closely to specifically assess grasping ability in infants that receive an ASD diagnosis later in life.

The study was funded in part by the National Institute of Mental Health, the Autism Science Foundation and ROAR for Autism.