1 A Comparison of Motor Delays in Young Children: Autism Spectrum Disorder, Developmental Delay, and Developmental Concerns Beth Provost, Brian R. Lopez, Sandra Heimerl Journal of autism and developmental disorders.

2 Introduction

3 Definition Difficulties in social interaction and communication Repetitive, restricted interests, and behavior

4 Researchers interested in Diagnosis Influence on behaviors Neuropsychiatric concepts treatment

5 Some researches were focus on the evaluation of the differences in ASD children's motor skill. Others compared ASD children with other children with developmental concerns.

6 Published researches focused on school-aged children Little information for younger children Inconclusive about difference in motor skill between ASD and other developmental problem

7 Analyzed home movies of children later diagnosed with ASD New insights Useful tools for diagnosis and rehabilitation

8 Purpose

9 Purpose of this study Evaluate motor skills of young children with ASD Presence and degree of motor delay Compare with other children who were also developmental issues

10 Questions for this study

11 Do young ASD child show delays as measured on BSID II Motor Scale and PDMS-2 Motor Scale ASD children vs. children with developmental issue ASD children vs. DD

12 Method

13 Participants Recruited from University Center for Excellence in Developmental Disabilities (UCEDD) Referred to Early Childhood Evaluation Program

14 56 children (21-41 mo) PS: Developmental concerns included language and social-emotional issues, and medical risk factors ASD19 DD19 NMD (no motor delay )  Developmental concerns without motor delay 18

15 The NMD group motor scores must be WNL on the BSIDII motor score and PDMS-2 total motor quotient BoysGirls ASD154 DD154 NMD126

16 Procedures Interrater reliability 2 PT vs. 6 children Video-taped and scores from the tape Tested and clinical setting by 1 PT while scored and observe by the other PDMS-291% BSID 2 motor scale96%

17 Instruments Bayley Scale of Infant Development- 2nd Edition (BSID II) Peabody Developmental Motor Scale- 2nd Edition (PDMS-2)

18 BSID 2nd Edition From birth to 42 months Consists of: Mental scale Motor scale Behavior rating scale Motor scales  Psychomotor Development index (PDI) scores

19 PDMS-2 Gross Motor Quotient Reflexes Objective Manipulation Stationary Locomotion Fine Motor Quotient Grasping Visual-Motor Integration

20 Data Analysis Multivariate Analysis of Covariance (MANCOVA) 1.If three groups differed on standard scores of motor development. 2.If groups differed on the standard scores of the subscales of PDMS-2 Covariance  Mental Developmental Index (MDI) from BSID2

21 Result

22 Descriptive statistics ANOVA: no significant difference among the groups in age (p=0.9) PS: The range of the age is months In BSID2 MDI standard scores, ASD and DD didn’t differ on cognitive abilities (p=0.5) Kruskal-Wallis test: p=0.67 (for gender)

23 Normative Data Standard scores Developmental age-equivalent

24 Normative Data

25 Normative Data

26 Analysis of Covariance 1st MANCOVA indicated that three groups differed on BSID2 Motor Scale PDI Scores (p<0.001) PDMS-2 Gross Motor Quotients (p<0.001) PDMS-2 Fine Motor Quotients (p=0.001) PDMS-2 Total Motor Quotients (p<0.001)

27 Analysis of Covariance 2nd MANCOVA found that three groups differed on all five subscales of PDMS-2 Stationaryp=0.001 Locomotionp=0.001 Object manipulationp<0.001 GraspingP<0.11 Visual-motor integrationP<0.001

28 Analysis of Covariance The Bonferroni-corrected post hoc analyses indicated that NMD group significantly differed from ASD and DD group ASD and DD did not differ on any of motor test

29 Discussion

30 Discussion In this study: At least one area of motor development was delayed At least 60% of children with ASD qualified for early intervention No one’s score fell into normal /average range on the BSID2 Motor Scale and all areas of the PDMS-2

31 limitation Current study showed that ASD children did not differ when compared to DD children Major limitation  increase likelihood of “typed I error” when using MANCOVA

32 Opposite aspect -1 67% of their sample of 3-15 y/o autism children had normal milestone of walking Mayes and Calhoun(2003) Motor skills in young ASD children are intact in independent walking Gillberg et al. (1990)

33 Opposite aspect -2 Such conclusion appears erroneous Retrospective parent report Gross motor skilled after independent walking are more complex Fine motor activities also require higher degree of motor planning and imitation

34 Support Find no distinctive when compare ASD group with motor impairment group Green et al. (2002) The need to assess the motor skilled of young ASD children Berkeley et al. (2001)

35 Conclusion

36 Conclusion Motor dysfunction in all ASD children with delays in gross motor and fine motor ASD and DD children showed significant impairment when compared to NMD No difference between ASD and DD

37 Further research

38 Further research Relationship of motor impairments with social and communication difference Any particular motor profiles in ASD children when compared with DD