What’s the relationship between motor skills and autism? Despite not being listed as a core trait of autism in the diagnostic criteria, differences in motor skill development are often the first traits seen in autistic children.
As such, we need to understand why the development of new motor skills is important. When parents and educators are informed, we’re better able to support our kids with what they need. So, today let’s discuss motor skills, autism, and the best ways to help autistic kids thrive as themselves.
What are Motor Skills?
Motor skills are a collection of movement-based skills that develop throughout childhood. These movement patterns are typically broken into two categories.
- Gross Motor Skills
- Fine Motor Skills
At each well-visit, doctors check for developmental milestones related to motor skills.
Gross Motor Skills
Gross motor skills include physical activity patterns using larger muscles of the arms, legs, and core. They’re typically whole-body movements that have varying degrees of difficulty.
- crawling
- walking,
- running,
- lifting objects
Specific activities that require balance and more complex coordination skills include:
- dancing,
- sweeping the floor,
- playing a sport,
- riding a bike
It’s also important to know that large gross motor skills lead to the development of fine motor skills. For example, the crawling milestone is foundational to the integration of the left and right hemispheres of the brain. Unfortunately, it’s often skipped in neurodivergent children.
Fine Motor Skills
Fine motor skills are physical movement-based activities that use the smaller muscles of the fingers, hands, and wrists.
Some common fine motor tasks include:
- using a crayon
- writing with a pencil or pen
- cutting with scissors
- using a spoon and fork
- manipulating small objects
Complex Fine Motor Skills
Typically, older kids and adults develop stronger manual dexterity. As such, they can master more complex fine motor skills such as:
- Playing with Legos,
- Threading beads,
- Knitting,
- Typing,
- Playing an instrument,
- Sewing,
- Manipulating the Xbox controller
- Speech (yes, speech is a fine motor skill)
It’s clear from both lists of motor skills that childhood play is an essential platform for kids to naturally develop and practice new skills. As kids grow, it’s important to provide them with lots of time to engage in play activities.
Speech Motor Skills
As I just pointed out, speech is a fine motor activity. In fact, according to neurosurgeon and neuroscientist Dr. Eddie Chang, Ph.D., MD,
The most complex motor action that we do is called speech.
Edward Chang, Ph.D., MD.- Decoding Speech, BrainMind Summit 2021
To his point, speech and language challenges are often related to differences in the cerebellum. (And, we’ll get to that more in a moment.)
Motor Skills in Childhood Development
It’s important to know that motor development and control have vast implications for children and adults in a number of areas.
- language development,
- learning,
- behavior,
- emotional control,
- sensory processing,
- social skills,
- and more
Additionally, childhood motor skill development also comprises the development of motor coordination.
Riding Bikes and Brushing Hair
Think of motor coordination as integrating the steps involved in riding a bicycle. Here are just a few of those motor skills related to postural control.
- Standing
- Balancing the bike
- core strength to stay upright
- Bilateral coordination
- both the left and right legs have to work together
- Use of arms, hands, fingers, wrists
- Oculomotor (visual-spatial)
- the brain has to correctly perceive distance through the eyes
Riding a bike can be very challenging for anyone with motor skill challenges such as autistic kids and adolescents.
Dr. Eddie Chang- Decoding Speech Motor Skill
This lecture by Dr. Edward Chang of the Chang Lab at UCSF offers brilliant insight into the complexities of speech. While not specific to autism, the education will be well worth it. Never stop learning, Friend.
Cerebellum and Motor Skills
The cerebellum plays a significant role in supporting motor movements throughout the body. Specifically, we know that the cerebellum works with the cerebrum (uppermost part of the brain) to modulate motor movements. The cerebellum impacts:
- Body awareness,
- Maintaining balance and good posture,
- Fine motor abilities,
- Eye-hand coordination,
- Speech production,
- and more
In general, the cerebellum is responsible for movement modulation. Modulation is providing the necessary support to make an action happen.
Motor Skill Development in Autism
To get an autism diagnosis, parents and kids must work within the current medical model. As such, the diagnostic criteria for autism says that autism is a neurodevelopmental disorder with primary differences related to:
- social communication
- repetitive behaviors (stimming)
- social interaction
So while doctors are looking for the traits in the diagnostic criteria, it’s well-known that autistic children commonly experience difficulties in motor skill development.
Diversity in Motor Skill Challenges in Autism
Differences in the structure and function of the cerebellum are believed to be the main contributor to motor skill difficulties in autistic children.
Additionally, it’s important to know that even within the larger autistic community, differences in motor skill development are vast.
In other words, not all autistic children have the same motor issues.
The motor challenges of one autistic child may be related to gross motor challenges (overall clumsiness). On the other hand, another child may only show a fine motor delay.
Unfortunately, this wide range of motor skill differences has prevented motor skill deficits to be included as a core feature in the current diagnostic criteria.
We’ll get to that more later.
Types of Gross Motor Challenges in Autism
Some difficulties in gross motor skills seen in autistic kids and teens include:
- General clumsiness
- Uncoordinated
- Difficulties catching a ball
- pumping legs on a swing
- jumping jacks
- Unique walking patterns or gaits
- toe walking, for example
- Bilateral coordination challenges
- Low muscle tone
- Poor core strength
- Posture issues (look hunched over)
- Difficulties with balance
We also see difficulties with motor planning specific to fine motor skills.
Common Fine Motor Skill Issues in Autism
Autistic children struggle with the execution of various fine motor physical activities. Common fine motor difficulties some autistic children may experience include the following.
- handwriting,
- opening jars,
- manipulating silverware,
- hygiene-related activities,
- brushing hair
- washing hair
- shaving
- brushing teeth
- Speech production,
- childhood apraxia of speech
- articulation disorders
- fluency disorders
Let’s spend a brief moment addressing speech in autism.
A Note About Hygiene in Autistic Teens
Autistic girls often struggle terribly with brushing their hair.
The motor coordination required to brush one’s hair is taken for granted. And autistic teen girls struggle with this because they often don’t have the cognitive bandwidth to do it.
Parents often fight their girls about these issues as if they’re lazy. This is untrue and can lead to devastating consequences including damaging the parent-child relationship.
Kids succeed when they can. Autistic adolescents need tools, not consequences.
Speech Disorders in Autism
It’s important to emphasize that speech delays and communication disorders are motor-based challenges.
Additionally, autistic children have high rates of difficulties in other areas of language and communication.
- reading challenges,
- comprehension,
- dyslexia,
- inability to follow directions,
- auditory processing disorders
Even if your child is or was an “early talker,” it’s important to be aware of later speech and language difficulties.
“Floppy” Early Motor Skill Milestones
So, we’ve reviewed potential motor skill challenges in autism. However, looking at these signs, it’s clear that a lot of them progress as kids grow older.
Fortunately, awareness of early childhood motor developmental delays is the first step to identifying cerebellum-related issues.
Some signs to look for in infancy and toddlerhood include motor delays and motor control difficulties.
Around 4 months of age, most babies have the muscle strength to hold their heads up when you lift them to a vertical position.
If you notice your child’s head flopping backward or forwards, it’s important to discuss it with your child’s pediatrician.
Other Early Motor Skills to Look For
Further, additional signs include delays or challenges with:
- Holding head upright
- Sitting
- Crawling
- Standing
- Walking
If your baby or toddler demonstrates gross motor delays in these areas, discuss them with your child’s pediatrician.
Regardless of the reason behind the gross motor delays, you’ll want to pursue professional support for delayed or deficient motor skills.
Then, in time, you and your medical team will determine whether those motor skill issues are indicators of autism.
Neurodevelopmental Conditions, Motor Skills, Cerebellum
Data compiled in 2013 used a movement assessment battery to look at motor skills in children. That data indicated that 80% of autistic children have gross motor difficulties. However, we know that delays in motor skills development are not always indicators of autism.
Developmental disorders such as Developmental coordination disorder (DCD) are related to delayed development of motor skills.
Delayed developmental milestones such as sitting, crawling, standing, and walking are some signs of DCD.
While DCD (dyspraxia) is considered a distinct condition, a significant portion of autistic children and adults will be diagnosed with DCD.
Joint Hypermobility
Further, joint hypermobility, sometimes referred to as Ehlers-Danlos syndrome, is an extremely common and often debilitating condition common in autism. This joint hypermobility can impact motor skills such as handwriting and other gross motor skills.
What We Know About Differences in the Cerebellum
As mentioned earlier, the cerebellum is a huge player in motor skill coordination. Cerebellum damage in premature infants and young children is implicated in several previously mentioned developmental disorders.
For example, in neurodevelopmental differences such as DCD, ADHD, and dyslexia, there’s evidence of cerebellum differences. Some common consequences of structural differences in the cerebellum include:
- behavior problems
- social withdrawal
- attentional issues
- emotional dysregulation
As mentioned earlier, research indicates that differences in the cerebellum are a core feature of challenging symptoms of autism.
What Does the Research Say About Autism Motor Skills?
Here’s part of the problem. As with the autism spectrum itself, the motor deficits parents and experts see in autism are vast covering a wide range of skills.
- gross motor
- fine motor
- speech and language (remember, speech is a motor skill)
- visual (oculomotor)
Each young child can have a unique motor skill picture. This has made it challenging for experts to identify and define motor development criteria to look for.
Recently, however, researchers have begun exploring the commonalities of motor skill challenges in autism. In their analysis, they started to question data collection tools used in previous research.
Problems with Previous Research
Experts point out that differences in age and intellectual level of participants in prior studies on motor skills in autism have led to inaccurate findings.
For example, in one study, researchers assessed the motor skills of younger children. In another study, the motor skills of autistic teens and young adults were examined. Previous research studies have included children without intellectual disabilities. Others have included kids with a wide range of cognitive development.
In the end, the inconsistency in measuring tools gives an inaccurate picture of the cerebellum and movement difficulties in autism. As such, researchers are pushing for future studies to better evaluate the connection between the cerebellum and motor skill difficulties in autism.
Strengths-Based Lens on Autism
Before we dive into the treatment options for motor skill challenges specific to autism, it’s important to be on the same page.
Here at A Heart for All Students, the goal is to equip moms raising neurodivergent children to thrive as exactly who they are. We believe every single child has gifts, passions, and purpose.
As such, we use a strengths-based lens on all children. This means that we stand with the adult autistic community.
Honoring Rather Than Pathologizing Language
We use neurodiversity-affirming language that honors rather than pathologizes people for their differences.
The most recent research suggests that the autistic community as a whole prefers identity-first language. This means, unless an individual autistic person requests otherwise, we use the term:
- Autistic person
We do not use the terms:
- autism spectrum disorder
- ASD diagnosis
- person with autism
- no functioning labels such as high-functioning autism
Just as importantly, it’s critical to the long-term well-being of our children that we seek out strengths-based professionals to support them.
3 Types of Neurodiversity-Affirming Therapy for Kids
I always recommend seeking out neurodiversity-affirming specialists to support your entire family, but most especially autistic children and teens.
Specifically, when looking for support for your autistic child’s motor skill difficulties, I recommend the following pediatric professionals.
- occupational therapist
- physical therapist
- speech-language pathologist
- trauma-informed mental health professional
Specific to the motor skills of your autistic child, seek an evaluation with a PRIVATE occupational therapist or physical therapist.
A private provider is not handcuffed by the red tape of a school system. As such, they can support your child’s underlying needs. Fortunately, most insurance companies cover this care.
1. Occupational Therapy
While occupational therapists cannot diagnose autism, they can be an integral part of your child’s team. A good private occupational therapist will complete a full evaluation to determine root issues related to your child’s motor problems.
For example, it’s well-known that autistic people have unique sensory processing experiences. Different ways the sensory system receives and processes sensory information can significantly influence motor movements.
Sensory Processing and Autism Motor Skills
In kids who toe walk, for example, a sensory issue related to the vestibular and proprioceptive systems contributes to this unique gait pattern.
Further, the brain’s ability to process incoming visual information works in combination with the vestibular sensory system to support the child’s balance.
A child with gross motor skill deficits may also have visual-motor deficits that lead to challenges with hand-eye coordination.
Ultimately, a good occupational therapist will help identify and treat underlying sensory and ocular motor (vision) issues to help your child’s motor skills.
Additionally, they’ll create an occupational therapy treatment plan, and support the development of important motor skills through fun activities.
2. Physical Therapy
A physical therapist can be an asset to your child’s team as well.
Physical therapists can help children develop core strength to improve motor movements.
Additionally, a pediatric physical therapist can help with functional skills such as learning to ride a bike.
3. Trauma-Informed Mental Health Professional
A trauma-informed mental health professional can greatly support your autistic child.
Autistic children and adults live in a world designed in direct opposition to them. Autistic children expend massive amounts of emotional and cognitive fuel just to perform small motor movements that are natural for typical children.
Because of this, they struggle against demands that are beyond what they can do… yet. As such, they constantly hear what’s wrong with them. Understandably, this leads to low self-esteem.
Marginalization and Mental Health in Autism
Under the medical and educational model used today, autistic people have suffered marginalization, trauma, and devastating mental health challenges.
This is why we must listen to the autistic community as real autism experts. So we can change the narrative for the next generation.
A trauma-informed therapist can be one of the best supports for a neurodivergent child or adult. Have hope and be the CEO of your child’s team. Oh, and if any professional or educator doesn’t want your or your child’s input, fire them.
Strengths-Based Motor Skills in Autism
In Motor Skills and Early Developing Brain Structures in Autistic Individuals, Elizabeth Torres, Ph.D., Brittany Travers, Ph.D., and Jen Schonger discuss strengths-based research. They also highlight using video game-based balance training to support motor skills in autistic children.
Supporting Your Child’s Motor Skills at Home
In the end, your child’s therapy sessions will never equate to the time spent in your care. This means you have a lot of power to support your child. As such, there are many ways to support your child at home.
First, of all, let’s talk play. Especially self-motivated, free play. Self-discovery helps children acquire essential motor skills that will support later learning and development.
- Child-led play,
- Outdoor time,
- Sensory toys and tools,
- Emotional regulation support,
In the end, neurodivergent kids are wired differently than neurotypical children. This means that we need to make different choices to serve their unique needs.
Considerations for Parents
Questions to consider as you support your autistic child:
- What’s their next step?
- No matter how small.
- How can I help them feel safe enough to hear me?
- Relationship first.
- How can I pour into my relationship with them?
- Do I need to reconsider my expectations of them?
- Is their current educational environment healthy for them?
- What educational alternatives may be better for them?
- Private school? Home education?
- What do I want them to believe about themselves now and into adulthood?
Lean into your child’s strengths, and look for their gifts.
If you need support, join A Heart for All Students Private Facebook Community. Moms don’t let moms do this thing alone.
Recap: Motor Skills in Autism
We moms must educate ourselves in the latest research so that we can take a proactive role in advocating for our kid’s needs. If your child is autistic, know that they are a gift to this world. There’s no need to change them.
Given the right opportunities, early intervention can help autistic children strengthen motor skills that may be challenging. And even if your child is older, it’s never too late to help them take their next step.
The more information you have as a parent, the better able you are to advocate for your child to get the support they need to thrive.
So, Friend. Is your autistic child navigating life with motor skill difficulties?
About the Author:
Lindsay is a trauma-informed educator with a Master’s Degree in Teaching. Her mission is to support moms to equip neurodivergent kids (ADHD, Autism, Dyslexia, Anxiety) to thrive as exactly who they’ve been created to be. Wait until you hear the story that led to it all…
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