Motor Disorders in Autism: From Comorbidity to Core Criterion.
Mohamed Jaber
PMID 42297632WHAT IT FOUND
Motor signs like gait asymmetry, toe-walking, and postural instability are common in ASD and may precede social deficits.
The authors propose these become diagnostic criteria rather than comorbidities, with a two-tier assessment framework for early screening.
Key findings
01Motor disturbances such as delayed head control, axial hypotonia, and gait alterations are detectable in infancy, sometimes before social deficits become clinically apparent, suggesting they may be developmentally primary rather than secondary to ASD.
02The authors propose that motor signs become diagnostically relevant when at least two distinct motor atypicalities (for example, persistent toe-walking beyond age 3 plus gait asymmetry or oral-motor dysfunction) co-occur with at least one sociocommunicative deficit, rather than serving as standalone criteria.
03Motor signs are not pathognomonic of ASD and overlap with DCD, ADHD, and idiopathic delays; their diagnostic value lies in their pattern, persistence across developmental stages, and interaction with core autistic traits.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review with no described search strategy, inclusion or exclusion criteria, or quality appraisal of the studies it cites, so the evidence base it synthesizes may be incomplete or skewed toward positive findings. The proposed diagnostic thresholds (at least two motor atypicalities plus one sociocommunicative deficit) are the authors' proposal, not validated against a diagnostic gold standard in a prospective cohort. The review acknowledges that motor signs are not pathognomonic of ASD and overlap with DCD, ADHD, and idiopathic delays, so the specificity of any single motor sign is limited. The cited evidence spans a wide range of study designs and populations (infants through adults), and the review does not assess the quality or consistency of findings across these studies. The authors note that current clinical practice for motor assessment in ASD is unevenly distributed and far from universal, so the proposed framework has not yet been implemented or tested in routine care.
Declared interests
The author declares no conflicts of interest.
The easy way to misread this
Do not read this as evidence that gait asymmetry or toe-walking alone indicates ASD. The paper states explicitly that these signs are not pathognomonic and overlap with DCD, ADHD, and idiopathic delays. The authors' own proposed threshold requires at least two motor atypicalities combined with at least one sociocommunicative deficit before the cluster becomes diagnostically relevant.