Background: A rapidly growing literature supports the presence of extensive motor alterations in autism, with effect sizes ranging from 0.87-1.85. This observation has recently prompted a debate about the opportunity of adding motor to the autism definition in future revisions of diagnostic manuals. Whether and to what extent these impairments are specific to autism represents a hot topic within this debate. Previous research suggests that motor difficulties could be common to other neurodevelopmental conditions, but those observed in autism are more severe and persistent. To date, no studies have compared motor skills in autism and attention deficit/hyperactivity disorder (ADHD) through the concurrent use of standardized motor tests, caregiver reports, and kinematic analysis of an upper limb action task. The hypothesis examined in the current study is whether this multimodal approach has the potential to identify more fine-grained motor profiles, specific to each condition. Objectives: To determine whether a multimodal assessment of motor skills could accurately discriminate autistic children from both ADHD and typically developing (TD) peers. Methods: 75 children aged 7-13 years and with a full-scale intelligence quotient (IQ) > 80, equally divided into three groups (autism, ADHD, TD), were assessed with the Developmental Coordination Disorder Questionnaire (DCDQ), the Movement Assessment Battery for Children – 2nd edition (MABC-2), the sensorimotor subtests of NEPSY-II, and the kinematic analysis of a reach-to-drop task. Two different principal component analyses (PCA) were applied to MABC-2/NEPSY-II scores and to the 17 kinematic features, respectively, to reduce the quantity of dependent variables while retaining the variation present in the data set. Group differences on DCDQ, PCA1, and PCA2 scores were then analyzed by multivariate analysis of covariance (with age and IQ as covariates). Last, three separate logistic regression models (autism vs TD, ADHD vs TD, and autism vs ADHD) were used to predict group membership based on variables showing between-group differences at analysis of covariance. Results: Results from PCA on MABC-2/NEPSY-II identified three factors —namely, Object Interception & Balance, Motor Imitation, and Fine-Motor Skills—, whereas PCA on kinematic variables identified four factors, as previously done (Crippa et al., 2021). In the model comparing motor functioning of autistic and TD children, DCDQ total score and Motor Imitation factor predicted membership with an accuracy of 87.2%. In the model comparing ADHD and TD group, Fine-Motor Skills predicted membership with an accuracy of 79.6%. In the last model, Object Interception & Balance factor differentiated autistic from ADHD children with an accuracy of 73.5%. Conclusions: The present study shows that specific motor profiles in autism and ADHD can be isolated with a multimodal investigation of motor skills. On one hand, this study adds to prior studies documenting distinct motor difficulties in autism on standardized measures of motor function. On the other hand, in line with our recent findings (Crippa et al., 2021), kinematics did not differentiate school-aged autistic children from ADHD and TD peers, substantiating the evidence that kinematic measures could be more appropriate for identifying autistic toddlers (Crippa et al., 2015).
De Francesco, S., Fioravanti, M., Morello, L., Cassaro, C., Busti Ceccarelli, S., Nobile, M., et al. (2023). A Multimodal Approach Can Identify Specific Motor Profiles in Autism and Attention Deficit/Hyperactivity Disorder. In 2023 Annual Meeting INSAR, May 3-6, Stockholm, Sweden (pp.1007-1008).
A Multimodal Approach Can Identify Specific Motor Profiles in Autism and Attention Deficit/Hyperactivity Disorder
De Francesco, S;Fioravanti, M;Crippa, A
2023
Abstract
Background: A rapidly growing literature supports the presence of extensive motor alterations in autism, with effect sizes ranging from 0.87-1.85. This observation has recently prompted a debate about the opportunity of adding motor to the autism definition in future revisions of diagnostic manuals. Whether and to what extent these impairments are specific to autism represents a hot topic within this debate. Previous research suggests that motor difficulties could be common to other neurodevelopmental conditions, but those observed in autism are more severe and persistent. To date, no studies have compared motor skills in autism and attention deficit/hyperactivity disorder (ADHD) through the concurrent use of standardized motor tests, caregiver reports, and kinematic analysis of an upper limb action task. The hypothesis examined in the current study is whether this multimodal approach has the potential to identify more fine-grained motor profiles, specific to each condition. Objectives: To determine whether a multimodal assessment of motor skills could accurately discriminate autistic children from both ADHD and typically developing (TD) peers. Methods: 75 children aged 7-13 years and with a full-scale intelligence quotient (IQ) > 80, equally divided into three groups (autism, ADHD, TD), were assessed with the Developmental Coordination Disorder Questionnaire (DCDQ), the Movement Assessment Battery for Children – 2nd edition (MABC-2), the sensorimotor subtests of NEPSY-II, and the kinematic analysis of a reach-to-drop task. Two different principal component analyses (PCA) were applied to MABC-2/NEPSY-II scores and to the 17 kinematic features, respectively, to reduce the quantity of dependent variables while retaining the variation present in the data set. Group differences on DCDQ, PCA1, and PCA2 scores were then analyzed by multivariate analysis of covariance (with age and IQ as covariates). Last, three separate logistic regression models (autism vs TD, ADHD vs TD, and autism vs ADHD) were used to predict group membership based on variables showing between-group differences at analysis of covariance. Results: Results from PCA on MABC-2/NEPSY-II identified three factors —namely, Object Interception & Balance, Motor Imitation, and Fine-Motor Skills—, whereas PCA on kinematic variables identified four factors, as previously done (Crippa et al., 2021). In the model comparing motor functioning of autistic and TD children, DCDQ total score and Motor Imitation factor predicted membership with an accuracy of 87.2%. In the model comparing ADHD and TD group, Fine-Motor Skills predicted membership with an accuracy of 79.6%. In the last model, Object Interception & Balance factor differentiated autistic from ADHD children with an accuracy of 73.5%. Conclusions: The present study shows that specific motor profiles in autism and ADHD can be isolated with a multimodal investigation of motor skills. On one hand, this study adds to prior studies documenting distinct motor difficulties in autism on standardized measures of motor function. On the other hand, in line with our recent findings (Crippa et al., 2021), kinematics did not differentiate school-aged autistic children from ADHD and TD peers, substantiating the evidence that kinematic measures could be more appropriate for identifying autistic toddlers (Crippa et al., 2015).
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