Motor problems in autism: an urgent need for recognition and action from early childhood
Motor difficulties in autistic individuals have been observed for decades, yet they remain underestimated and poorly addressed within the clinical system. In other words, a child with ASD is not simply a child who doesn’t speak or avoids eye contact.
The article by Kilroy et al. (2023) Motor problems in autism: A call to action for the creation of an evidence-based clinical pipeline highlights that between 50% and 95% of people with autism present significant motor problems, such as difficulties with balance, coordination, and performing fine and gross motor tasks. Despite their frequency, these difficulties are formally diagnosed in only about 1% of cases.
This mismatch between evidence and clinical practice creates a critical gap in care. Motor difficulties do not only affect movement—they also limit autonomy, nonverbal communication, social interaction, and cognitive development. From early ages, children with autism may show delays in sitting, crawling, or walking, as well as difficulties engaging with their environment and peers through physical play.
Why are these difficulties not being diagnosed?
Although current diagnostic manuals (DSM-5 and ICD-11) allow for an additional diagnosis of Developmental Coordination Disorder (DCD), this is rarely made. Nor is motor development accurately assessed.
Why?
- Minimum age for diagnosing DCD: Like other neurodevelopmental disorders, DCD is diagnosed starting from 5 years of age, missing key early intervention opportunities and preventing timely prevention efforts.
- Lack of awareness among professionals and families.
- Scarcity of specific tools adapted for autism.
The article proposes adding a diagnostic specifier of “with or without motor impairment” within the autism diagnosis, as is already done with language difficulties or intellectual disability. This would allow the recognition and treatment of motor difficulties from an earlier age, improving access to physical therapy, occupational therapy, and other adapted activities.
🍼 How to detect motor difficulties in infants?
Detecting motor problems from the first months of life can make a huge difference. Here are some early warning signs and practical recommendations for parents and professionals:
🔍 Early warning signs (0 to 2 years):
- Delays in reaching motor milestones (e.g., not sitting independently by 9 months or not walking by 18 months).
- Repetitive or poorly coordinated movements.
- Avoids physical play or shows little initiative to explore the environment.
- Difficulties manipulating objects with their hands (e.g., grabbing a rattle, transferring objects between hands).
🛠️ Recommendations for early evaluation:
- Observe milestone progression: Compare to developmental guidelines, keeping in mind that each motor milestone allows for a normal range of variation.
- Use the Alberta Infant Motor Scale (AIMS): Or other scales that systematically assess motor development during the first year of life.
- Record free play sessions on video: This can help a specialist evaluate the child if concerns arise.
- Educate families: Teach them how to naturally and calmly detect possible difficulties in the baby’s acquisition of motor and postural achievements—avoiding alarmism, as sometimes seen on social media.
💡 Conclusion
Recognizing motor problems as an integral part of the autistic profile is an opportunity to improve quality of life from early childhood.
In this regard, I recommend the chapter by Professor Javier Merino in the book “Trastornos del neurodesarrollo. Un abordaje integrativo en la evaluación y el tratamiento”.
You can find it here.
Detecting and acting early can help children develop greater autonomy, social participation, and physical and emotional well-being.
For evaluating motor and postural development in infants, the Alberta Infant Motor Scale (AIMS) stands out. Remember, you have access to an online course on motor development evaluation with AIMS available until April 30. Check it out here.
The proposal by Kilroy and colleagues is not just a call to action for professionals: it is also an invitation to families, schools, and communities to observe, understand, and act. Because movement is not only about getting from one place to another—it is also a way of connecting with the world.
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