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Educating patients that are carring a fetus to embroy till the last week of pregnancy is important. Giving out mothers advice to exercise, and take the time to teach them about better eating habits could help reduce the chance of a baby being born with autism. The mother should also recieve tips from her provider to stay active so she not only stays healthy but for the baby. Going to checkup and the mother educating herself outside her provider is important. Taking vitamins and other supplements are ways she can take to stay healthy. Education is important to decrease chances of baby being born with Autism

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Applying case management to families and individuals effected is an approach to control the consequences of Autism. It incorporates a specialist's treatment plan along with other professionals, such as teachers, to aid in facing challenges. Case management may build consistent resilience to the individual and family. Barriers to this type of intervention include lack of insurance and high out of pocket costs for seeking out clinicians.

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Applied behavior analysis helps people with autism live safer and more fulfilling lives. Applied Behavior analysis focuses on teaching necessary skills and stopping dangerous behaviors. Some skills that are improved with this strategy are communication and language skills, as well as social skills, self-care and hygiene routines, and motor abilities. Some challenges that come with ABA is that not only is it expensive, but its difficult to teach parent and teachers strategies and interventions for their child or student.

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A foundational public health intervention to get would be prenatal care. The second a mother knows that they are pregnant it is crucial that they keep up on prenatal care in order to find any diagnosis inculding ASD early enough to start treatment if wanted. A barrier is mothers not knowing if they are pregnant, insurance/cost issues or access to healthcare.

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Visual timers are very supportive when it comes to assisting someone with Autism. It fact, they can be used almost in all situations. These timers are adaptable and portable. Some benefits to using a viausl timer is that it provides structure and routine to the patient. While it provides a structure and routine the patient will start to build independence which build condifidence in the patient. Some good outcomes of using visual timers is that it builds confidence and improves understanding for patients with Autism. This device is well recommended by therapists for people with ADHD as well as Autism. There are not known causes side effects of using visual timers although having children already on time schedules it can cause outside people or others to accommodate. For the patient it helps them more although it could cause in the beining some stress but ease over time.

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Socially assistive robots are used to help Autistic children with behavioral patterns. The robot performs in a reward based system. It sounds a noise or gestures in a certain way only when the user carries out a certian action.

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The eye-tracking technology is a screening tool, also known as the GeoPref test. It consists of using infrared light to follow the eye movement of the child as they watch certain things, such as series, movies, and geometric shapes. The eye-tracking technology is used to help diagnose autism, by offering the ability to detect autism in children from early as 16 months to 30 months. Although eye-tracking technology is beneficial, it's very expensive for companies to purchase and maintain. Which leads to the data that's being gathered by the eye-tracking technology being complicated to understand.

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The Rs-fMRI machine is a sister machine to the MRI, however its main ability is to check the connection and conductivity in the pathways of the brain. Certain pathways that do not get used or have low conductivity have been linked to the diagnoses and treatment of Autism. Scans can even be done while to fetus is still in the mothers womb.

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According to "The Prenatal Hormone Milieu in Autism Spectrum Disorder," changes in placental transcription throughout pregnancy may be used as a way to detect ASD early on. The placenta is crucial for fetal development and an adverse environment is a contributor to ASD. Complications with placenta also cause risk factors for ASD to arise, including: maternal infection, metabolic complications, and fetal growth restrictions. Disruption to the healthy development of placenta may be caused by stressors, inflammation, and metabolic disturbances. Another study identified that the thickness of placenta was also correlated to offspring having ASD.

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The environment plays a very important role in determining the risk of autism, along with genetic, and epigenetic factors. Environmental factors can affect the quality of gene expression without having to change the DNA sequence through epigenetic factors. Epigenetic changes can result in changes in the genetic expression of pathways enzymes which causes a change in the folate level. The folate level then leads to the contribution of Autism. Environmental Enrichment, in the form of sensory enrichment therapy, is one of the early treatments. This consists of different types of sensory and motor exercises daily. Sometimes theirs thermal stimulation, visual, Auditory, proprioceptive, and vestibular stimulation, and balance skills. These therapeutic exercises are administered once or twice a day, with each session lasting 10-15 minutes.

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In a recent research article published in 2021, it found that the upregulation of PI3K-AKT/mTOR pathway is involved in the pathogenesis of autism. The article mentioned that new drug therapy can be used in order to start firing that pathway and assist the symptoms of ASD. In fact, there are already inhibitors used to treat other neurological diseases such as Parkinsons, TBI, Down Syndrome etc. The article also includes a table that shows all the different parts and ways the brain is affected with the PI3K-AKT/mTOR pathway. One con to this is that since this is new research, even though there is a drug insurance companies are not likely to cover new drugs and will cause the patient to pay out of pocket. In order to be able to identify ASD the mother must be up to date on prenatal visits so they can prepare treatment like such as early as possible. The article also explains the importance of visits as soon as possible but could also lead to financial and uninsured patients being unable to do so.

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Other than genetics, a leading cause of autism is substance abuse in pregnant mothers. Statistically, these individualized are also low income. So not only is the dependent guarding not a stable caretaker it makes administering care for their autistic child harder, and therefore makes it harder on the child to receive care if the income goes towards drugs instead of therapy or specialized schools.

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A Special population commonly seen in Autism is male children, they are nearly 4 times more likely to be diagnosed with autism than girls. Children are affected by autism due to genes. Children with Autism have problems with their brain structure or chemicals in the brain. Children have to depend on a guardian as well as have to deal with autism itself. Parents of autistic children may face the challenge of their treatment being unmet.

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Exercise is very important for people with autism since physical activities such as walking, dancing, yoga, martial arts, jogging, or more specifically grab ball complex, Ball tap complex, Hurdle step-overs, and Bear crawls are great with helping reduce repetitive behavior. Exercise also helps with other common symptoms seen in autistic children such as anxiety, and depression. As well as improve social and communication skills. A professional who might help a person make these lifestyle changes are physical therapists as well as other healthcare professionals. To make this style change the difficulty level would be a 5 due to the different starting points of the children with ASD and the different benefits.

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ASD patients need a whole village in order to take care of them. Including this is parents of ASD children, everyone is involved, and everyone's lifestyle gets effected. One lifestyle change is choosing to homeschool your ASD child. In this way is your child has social anxiety and is not comfortable around anyone other than the parents this is a great way for them to still get education. If the child has less social anxiety, then choosing to enroll the child in an ASD specific school can also be very beneficial since they know how to properly take care of those kids. The professionals needed would be trained paraeducators and licensed special ED teachers. This kind of lifestyle change would be around a 7 on difficulty due to the low number of vacancy in schools.

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Homeschooling Autistic Children (My 3 Essential Tips!)

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In people who are higher on the spectrum of ASD these people are highly immobilized and likely wheelchair bond. For these people physical therapy can be life changing in helping with basic motor skills. Grasping, finger movement, strength training etc. Little improvements are made overtime and help these patients tremendously. It is crucial to start this therapy as young as possible. The type of professional needed would be a licensed physical therapist. However, there are also therapist who specialize in autistic children. Therapist can be found at aptaapps.apta.org .

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The Importance of Physical Therapy Treatment with Autism: Pediatric Physical Therapy for Autism #1

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Studies have suggested that hearing loss and autism are linked. A treatment for this includes hearing aids or cochlear implants. These treatments are devices that can help individuals with hearing loss. With low-gain hearing aids are beneficial for conditions like autism and sensory processing disorders. An Audiologist can treat autistic people with hearing aids.

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Cognitive Behavioral Therapy is an effective treatment for a range of mental and emotional health issues. Which include Anxiety and Depression. These two mental health issues are symptoms commonly seen in people with autism. Cognitive behavioral theory teaches you to think in a more positive way instead of focusing on the negative. Cognitive Behavioral Therapy is a short-term effect that helps those with mental and emotional health issues change the way they feel. A licensed mental health professional such as a psychologist, social worker, and even a professional counselor is able to treat this therapy.

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#CBT - What is cognitive behaviour therapy? | Pinnacle Blooms Network - #1 Autism Therapy Centres

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Social training is used to aid in the inability to read non verbal cues. It consists of practicing what to do in certain scenarios, modeling behaviors, and corrections. A therapist or teacher is able to carry out this rehabilitation. Social Skills is a long term effect because this therapy effective to younger kinds and last up to a life time.

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How to Improve Social Skills for Young Adults with Autism Spectrum Disorder- Strategies that Work

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According to MDsave the cost Speech Therapy vist in Arizona is from 140 to 149 dollars.  The amount that insurance can be covered for instance in arizona can be completly covered. AHCCS is one example according to azhcccs which states that AHCCCS covers physical, occupational and speech etc. services. It does need to be rodered by a physician and be provided under a type of direct supervision of therapist. However, there are some insurance companies that decline coverage for these treatments as casrf states they can not be "medically necessary" to some companies. Without speech therapy many Autism patient can experience a difficulty with speech and might fall behind in speech communication as the get older.

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Behavior and communication therapies usually range from $120 to $150 hourly. Usually, Insurance does cover behavior and communication therapies for autistic people. It is very important for autistic people to get this treatment because it helps them increase their language and communication skills. Many autistic people usually get other medical conditions, such as anxiety, depression, or attention deficit hyperactivity disorder. This is why it's very important for people with autism to also get behavior therapies.

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One long term treatment for Autism is cognitive behavioral therapy. The initial evaluation cost to match a patient with a therapist is $350. Following appointments range from $100-$200 per session depending on the therapist. Luckily, insurance is likely to cover these expenses due to the Mental Health Parity and Addiction Equity Act. Long term consequences if treatment is not sought out include anxiety and depression.

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Drug therapy can be complimentary to other therapies for people on the spectrum. One of the most common drugs is methylphenidate hydrochloride. Insurance is very likely to cover this drug and only make it a few cents, however if one does not have insurance and average out of pocket cost is $33. Certain drug therapies can work better than other therapies for ASD patients, if one chooses not to undergo drug therapy it can mean the difference between social communication and day to day function/quality of life.

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Autistic people are more likely to experience feeling loneliness compared to people without autism. Some autistic people choose to not interact with others due to struggling to interact with others. In most cases, this is due to people without autism not welcoming them, making autistic people feel more comfortable being on their own.

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People with Autism may potentially suffer from a sleeping disorder such as insomnia or sleep apnea. On average, it takes them 11 minutes longer than the normal person to fall asleep.

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People who have Autism have difficulty forming and mainting friendships through their life. This is due to having trouble understanding what is being told to them as well as having difficulty communicating.

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People with ASD tend to have heightened senses. Many symptoms of Autism are shared with social anxiety, such as difficulty concentrating, irritability, language and genetic factors. Therefore, a high percentage of ASD patients also suffer from high social anxiety.

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Autism can be diagnosed through giving the child a structured test or by the results of a questionnare.

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Children with Autism often respond well to educational therapies. These therapies help people with autism since they help them develop social skills, improve language competency, and good behavior using reinforcement techniques.

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According to the CDC there are not any specific test to diagnose ASD children however behavior helps a lot in diasgnosing.

This can be detected at a very young age of 18 months.

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Due to the lack of social skills many ASD children deal with, they are not motivated to engage/keep eye contact.

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Autism Signs Appear Early in Infant Eye-Contact Test

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A symptom commonly viewed in Autistic people is unusual mood or emotional reactions. This could be seen as tantrums, hitting or injuring themselves or others, yelling, or even acting in a silly mood.

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A symptom of ASD is the delay of gross or fine motor skills. This can make children who have Autism reluctant to participate in certain activities.

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Abstract

Objective: This study was conducted to determine the gross and fine motor profiles of children with autism spectrum disorder compared to typically developing children. Additionally, we also assessed if the motor delay was more pronounced with increasing age.

Method: This was a retrospective study involving children aged 12-60 months of age comparing motor development in children with autism spectrum disorder with typically developing children. Their developmental profile was assessed using Schedule of Growing Skills II. Descriptive statistics was used to analyse the developmental profile between the groups.

Results: ASD children had significant gross motor (6.7%) and fine motor delay (38.5%) compared to typically developing children, who did not show any delay. The motor delay in ASD children was more prominent in older children.

Conclusion: It is important to assess motor development in ASD children as there is significant motor delay in these children compared to typically developing children, and the delay becomes more prominent with age. Early detection of motor delay could allow provision of early intervention services to optimize developmental outcomes.

Keywords: autism spectrum disorder, autism, motor delay, gross motor, fine motor

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental condition that involves persistent challenges in social interaction, speech, non-verbal communication, and restrictive/repetitive behavior ( 1). The prevalence of ASD the United States is estimated to be 1 in every 54 children based on the data collected by the Centre of Disease Control's Autism and Developmental Disabilities Monitoring Network in 2016 ( 2). There are currently no reported large-scale prevalence studies in Malaysia. A feasibility study using the Modified Checklist for Autism (M-CHAT) in children aged 18-36 months performed in the Ministry of Health Malaysia (MOH) run health clinics in 2006 estimated the prevalence of ASD in Malaysia to be ~1.6 per 1,000 ( 3).

The diagnosis of ASD can be made clinically based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. While social communication impairment (SCI) is a one of the features, general motor impairment is not a part of the core criteria for ASD diagnosis. However, recent research has reported the presence of motor difficulty and delay in some children with ASD. Studies by using the Movement Assessment Battery for Children 2 (M- ABC2) in children aged 3-16 years reported up to 80% of children with definite overall motor skills impairment ( 4, 5) and a similarly, 80% of children with ASD was also reported to have gross motor delay when assessed using the Test of Gross Motor Development-2 (TGMD-2) ( 6). While, a more recent study examining data from the Western Australia Register, reported 35% of children aged <6 years old with an ASD diagnosis had motor difficulties based on the results of the Vineland Adaptive Behavior Scales ( 7). In addition to that, other earlier studies have examined the developmental trajectories of toddlers with ASD using the Mullen Scales of Early Learning (MSEL). These studies report similar observation, where by ASD children are generally delayed in all aspects of development, and this includes their gross and fine motor skills ( 8, 9).

However, some studies did not reach the same conclusion, for example, Ozonoff et al. in 2015 found that ASD on its own did not appear to account for motor delay in these children as delays in motor development were present in both children with ASD and children with other causes of developmental delay (DD) ( 10, 11).

Our study aims to shed further light on this subject especially within the context of an Asian population. The main objective of our study was to determine the profiles of gross and fine motor skills in children with ASD compared to typically developing (TD) children using the Schedule of Growing Skills II (SGS II), a developmental screening tool. We hypothesized that children with ASD were more likely to be delayed in their gross and fine motor skills compared to TD children. In addition, we wanted to assess if age was a factor in the delay of motor development by comparing motor development in younger (0-36 months) compared to older (36-60 months) ASD children. We hypothesized that children in the older age group were more likely to be detected to have delay in their motor function. In our study we did not look into more specific areas of gross and fine motor development such as walking, static and dynamic balance, praxis and hand-eye coordination.

Methods

Participants

This was a single-center retrospective study comparing children with ASD and typically developing children (TD). The participants were ASD children between the ages of 12 and 60 months seen at the Child Development Center (CDC) at Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Medical Centre (UKMMC), between January 1, 2018 and June 30, 2019, and typically developing children attending the hospital for other reasons or who were children of hospital staff.

A total of 152 children were shortlisted from our database for recruitment into the study based on their age and date of clinic appointment. After reviewing the medical records, 104 were found to be eligible for analysis after excluding those with incomplete data and those who fulfilled study exclusion criteria. Exclusion criteria were: (a) Confirmed or suspected genetic syndromes or ASD with potential secondary causes, (b) Children with focal neurological findings, (c) A significant past medical history that can lead to developmental delay such as hypoxic ischaemic encephalopathy, neonatal hypoglycaemia, head injury (d) Epilepsy, (e) Significant blindness or deafness, (f) Presence of any physical disability that could impact motor development.

These were excluded to reduce other confounding factors that might affect the motor performance in these group of children. We excluded these children with recognized co-morbidities such as genetic syndromes, focal neurological findings and seizures as we postulated that brain abnormalities that may be associated with these conditions may predispose to delay in gross or fine motor development, and we wanted to determine if the diagnosis of ASD alone without these co-morbidities is associated with motor delay. This may imply a different pathway affecting neurodevelopmental progress in ASD other than brain abnormalities that present with these co-morbidities. Children with visual impairment may have motor development delay due to lack of visual input, while those with hearing impairment may be more reliant on visual cues and have differences in motor development due to this, hence the reasoning to exclude these as well.

The data of the TD children was collected by convenience sampling. A total of 74 TD children were recruited. These were children that had a follow-up appointment in the general pediatric clinic at HCTM for minor illnesses such as non-complicated asthma or mild anemia, and any healthy children that were at the general clinic waiting room, as well as children of the staff in HCTM that came voluntarily for assessment. The parents were requested to fill up a questionnaire for screening of possible concern of any developmental delay and relevant medical history. Only children with non-significant medical history and no current developmental concerns were recruited for the study.

Instruments

Schedule of Growing Skills II

The Schedule of Growing Skills II (SGS II) is a developmental screening tool for children below 60 months of age. It is a tool adapted from the United Kingdom (UK) and designed by Dr. Mary Sheridan. Its purpose is to provide an accurate and reliable method of developmental screening; it is easy to use and requires little training. It is not an in-depth diagnostic tool, however it does provide pointers to the nature of the child's problem and assesses a child's development at a point of time. Although it is a British-based tool, SGS-II has been found to be a reliable and accurate tool for assessing development in disabled children in the local context based on a working paper by Haironi and Mariah from University Malaysia Sarawak in 2014 ( 3). In our center, the SGS II assessments are performed by trained CDC clinic nurses prior to consultation with the pediatric medical team. All children in the clinic were seen by either a pediatrician experienced in the diagnosis of ASD or pediatric medical officers under the supervision of the attending pediatrician. Children with an unclear diagnosis were referred to a special clinic with additional input from other members of the developmental team. Medical data was documented on a standardized history-taking sheet and diagnosis of ASD was made if the child fulfilled the diagnostic criteria for ASD based on the Diagnostic and Statistical Manual of Mental Disorder version 5 (DSM-5).

The SGS-II has 10 domains and is valid for use in children from birth to 60 months of age. The guideline defines "significant delay" as the developmental age being more than one age interval below the chronological age ( 12). This assessment uses a focused play based approach which includes clear instructions to guide the administration of the guided activities as well as gathering information from the parent or caregiver.

The diagnosis of autism spectrum disorder was made clinically based on comprehensive history, observation of child behavior and clinical examination. Diagnostic tools were used to assist clinical diagnosis, specifically criteria for ASD diagnosis under DSM 5. Early clinical diagnosis of ASD based on DSM IV, DSM 5 and clinical judgment remain at a mean age of 33 months and is stable over time in 96% of cases. Diagnostic stability is highest when clinical judgment is combined with multidisciplinary team assessment ( 13).

Statistical Analysis

For statistical analysis we utilized SPSS version 20. A p-value of 0.5 was considered to be significant. A Fisher exact test was used to test the relationship between two categorical variables with a small sample size.

Results

This study had a total of 178 children with 104 children from the ASD group and 74 children from the TD group. There were significantly more male children in the ASD group (88.6%) compared to the TD group and the mean age during which SGS II was administered was slightly younger in the ASD group. A higher proportion of TD children were from the Malay ethnicity compared to ASD children. Other characteristics such as parental age and maternal age at delivery did not differ between the two groups. This can be seen in Table 1 .

Table 1

ASD

TD

Mean (SD)

Mean (SD)

n(%)

n(%)

Gender

Race

Our results revealed that the ASD children were significantly delayed in all domains compared to the TD children, with a large percentage (83.7%) of the ASD children having cognitive delay. A smaller percentage of the ASD children also had significant gross motor (6.7%) and fine motor delay (38.5%), whereas none of the TD children had delay in any of these domains. In our sample, a small proportion of children in the TD group had receptive and expressive language delay, although this was not statistically significant. The profile of developmental differences between the two groups is shown in Table 2 .

Table 2

Developmental domains in SGS-II

Fisher's exact
test (p-value)

Locomotor

Manipulative

Visual

Hearing & language

Speech & language

Interactive social

Self-care social

Cognitive

We also found that all the ASD children with gross motor and manipulative delay had concomitant cognitive delay.

From our study, we found that all children who screened positive for significant gross motor delay were from the older 37-60 month-old cohort. A bigger proportion of children from the older age range also had fine motor delay compared to those in the younger age range. The results are presented in Table 3 .

Table 3

Chronological Age

Developmental domain

0-36
months
n (%)

37-60
months
n (%)

p-value
(Fisher Exact
test)

Locomotor

Manipulative

As we had performed convenience sampling and noted some differences in sex and age between the ASD and TD groups, we attempted to control for these by repeating the analysis with only a proportion of ASD children who were a closer match in terms of sex and age with TD children (Results in Appendix 1 ). This did not affect the results, and we found that gross and fine motor delay became more prominent with increasing age in the ASD group and there were no children in the TD group that had motor delay.

Discussion

We set out to determine the profiles of gross and fine motor skills in children with ASD compared to typically developing (TD) children in CDC UKMMC using SGS II, a developmental screening tool, and to assess if motor development delay was more pronounced in younger compared to older children with ASD. In our study we found that children with ASD had both significant gross motor delay ( n = 7; 13.2%) and fine motor delay ( n = 38; 52.5%), whereas delay in motor development was not seen in TD children. Significant gross motor delay in ASD children were seen only in those who were older (37-60 month old). For fine motor delay, a bigger proportion of the children from the older age range showed significant delay compared to the younger children (50.9 vs. 21.6%). In general, we found that children with ASD had significant developmental delay in all domains assessed by SGS II compared to typically developing children.

Our results are comparable to previous research published on ASD showing gross and fine motor delay in ASD children become more significant with increasing age, particularly work by Landa's group ( 14). It is not unexpected that a proportion of children with ASD would have global developmental delay which includes delay in the gross and fine motor domains. In our study, we were not able to ascertain if the presence of motor delay is associated with ASD purely, or if the motor delay is compounded by concurrent global development delay. It is well-established that intellectual disability is one of the known co- morbidities in ASD ( 15, 16). In our sample, a high proportion of ASD children were detected to have significant cognitive delay and all the children with gross motor delay were delayed cognitively. Current available literature available is not yet able to parse out the relationship between ASD and DD or intelligent quotient (IQ) scores) to gross motor delay due to the disparate nature of these studies. A recent review summarized that motor proficiency deficit can be present throughout the spectrum regardless of IQ ( 17). A more recent study by Kaur concluded that both fine and gross motor skills are related to the IQ level but not severity of ASD ( 18). In general, motor delay is present in children with ASD or DD and they are both significantly more delayed compared to their TD counterpart ( 10, 19).

The results of our current study are also consistent with previous studies with regards to the relationship between the age of a child with ASD and detection of motor delay, whereby motor delay becomes more prominent as the child grows older ( 9, 14). Even though there is evidence that motor delay could be picked up as early as 14 months in children with ASD ( 14), SGS II is a developmental screener and may not be as sensitive in detecting motor delay at an early age compared to more detailed and diagnostic developmental assessment tools that have been used in other studies such as the TGMD-2, MESL, M-ABC2, Bayley Scale of Infant Development II (BSID II) and Peabody Developmental Motor Scales, 2nd edition (PDMS-2) ( 6, 11, 14, 20). However, despite being a screening tool, SGS II was still able to pick up these differences at an older age, showing it potentially has good utility in older children for certain domains.

A previous study reported that ~33% of children with ASD have concomitant intellectual disability with IQ less that 70 ( 21). In our study we found that a large portion of children were also cognitively delayed, which may be associated with concurrent gross and fine motor delay. Unfortunately, we were not able to test this hypothesis with our study instrument. Praxis error may also give a clearer relationship between motor development and the severity of ASD ( 18). Unfortunately, we were not able to ascertain praxis error in our study due to the instruments we used.

From the review of literature, current research has not been able to conclusively use motor delay as an early marker for diagnosis of autism due to the disparity of research results ( 22). However, identifying motor delay may aid therapists in provision of more personalized therapy as motor skills may be linked to the development of other domains. LeBarton and Landa reported that early motor skills delay may be associated with delay in language development ( 23). In addition, gross and fine motor skills are also important to assist in advancement of adaptive living ( 24) and socialization skills ( 25- 27). Understanding that motor domains may be affected in children with ASD will provide clinicians and practitioners working with ASD children better awareness of the spectrum of difficulties these children face and enable earlier detection and intervention. These in turn are likely to improve outcome and quality of life of these affected children.

Our research found that about 8% of the children from the TD group that were screened had language delays despite their parents not reporting them as having any developmental concerns on initial questioning. While none of these children with language delays had features to suggest ASD, this finding is important in highlighting the hidden problem of developmental delay in children, specifically language delay, of which parents may not be aware. The language delay was picked up by the SGS II screening assessment which involves both; the language used by the child during assessment as well as focused questions on the child's language development in the parent interview as recommended by the assessment. The prevalence of language delay in our sample is slightly higher than expected and may not reflect community prevalence. The general prevalence of language delay is reported to be between 2.6 and 6% ( 28, 29). Many of the TD children were the children of our hospital staff that came voluntarily for assessment. We postulate that some parents may have come for screening to confirm or alleviate their unexpressed concerns regarding their child's development, although they did not state any concern regarding development specifically in the screening questionnaire.

There were a few limitations in our study. Firstly, we used the SGS II, which is a developmental screening tool instead of a diagnostic tool. The use of a screening tool may affect the accuracy of the developmental profile obtained, with subtle differences such as balance and coordination skills potentially not detected. In addition, we did not collect data regarding comorbidities such as intellectual disability or developmental disability, which may have been the main driver for the differences of motor development seen in ASD children compared to TD children. A systematic review by Paquet has suggested that a more complete assessment of motor function (walking, static and dynamic balance, coordination, manual praxis, hand-eye coordination) using standardized assessment tools taking into account the neuro-cognitive level would enable us to better understand the relationship between motor development and ASD ( 19). Thus, in future studies, use of more specific developmental tools and instruments for assessments of co-morbidities could further improve the study design and parse out true associations. In addition, in younger children, a more sensitive tool could be considered to assess motor delay, as we found the SGS II did not detect differences in younger ASD children.

Apart from this, we also found that there was a higher number of male children within the ASD group, with a ratio of 2.5 males: 1 female child. The children in the ASD group were also slightly younger. The excess in male children in the ASD group is not surprising as it has been well-established that there is a male preponderance in ASD, with current literature citing a male to female ratio between 3:1 and 4:1 ( 30, 31). These differences may be significant as recent evidence suggest that fundamental motor skills in boys and girls may defer across the preschool period ( 32) and it has also been reported that 4-year-old boys assessed by the M-ABC were found to score lower on the manual dexterity and balance score compared to the girls ( 33). We attempted to address this by re-analyzing the data and matching ASD and TD children by gender and age and found that the results were not altered significantly. In addition, our study did not investigate other compounding factors that may affect motor development such as the impact of growth, diet and environmental stimulation that may influence motor development.

In conclusion, our study shows that children with ASD are more likely to have delay in both gross and fine motor domains compared to TD children, and that this delay is more pronounced in older children with ASD. Even though SGS II is a screening tool, it may be useful in a resource-limited setting to assess developmental profile children with ASD. Earlier detection of developmental delay is imperative to enable provision of early intervention to optimize long term outcomes. In children with ASD, early intervention services should also promote gross and fine motor development in addition to communication and behavioral intervention. These motor skills are essential for overall developmental outcomes for all children.

Data Availability Statement

All datasets presented in this study are included in the article/supplementary material.

Ethics Statement

The studies involving human participants were reviewed and approved by the Universiti Kebangsaan Malaysia institutional research and ethics committee (Project code: JEP- 2019-302). Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Appendix 1

Fisher's exact
test (p-value)

Locomotor

Manipulative

Visual

Hearing & language

Speech & language

Interactive social

Self-care social

Cognitive

References

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Articles from Frontiers in Pediatrics are provided here courtesy of Frontiers Media SA

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Motor Development in Children With Autism Spectrum Disorder

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Objective: This study was conducted to determine the gross and fine motor profiles of children with autism spectrum disorder compared to typically developing children. Additionally, we also assessed if the motor delay was more pronounced with increasing ...

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People with Autism may show a presence of delay in developing language skills as well as having trouble understanding what is being told to them.

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Although there is no cure for Autism therapies have been the main treatment for the goal to improve function and quality of life. Most common form of treatment is communication/language therapy; to improve the hurdle of verbal communication in ASD children.

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Speech Therapy for Autism Spectrum Disorder

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In people with ASD many have struggles with cognitive processes such as decision‐making, planning and emotions. The frontal cortex is responsible for said things. Specifically, if one has ASD research has found that they have 7% more growth than non-ASD children. This overgrowth changes the anatomy of the brain and is mainly due to genetics.

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The insula is a structure involved with ASD. People who are diagnosed with Autism under medical studies have shown the decline in volume and thickness of this structure.

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The orbitofrontal cortex, located at the very front of the brain, is responsible for sensory integration and decision making. With damage to this part of the brain, or with those suffering from Autism, this can lead to compulsive behavior or anxiety.

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Studies show that amygdala affects the development of the brain that causes anxiety in autistic children.

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In people who are diagnosed with ASD, research has found that the density of neurons located on the cerebellum is significantly decreased. The cerebellum is the center for motor skills and speaking. With lower density of the volume and Purkinje cells people with ASD have struggles with control over movement and verbal speaking. The reason for decrease in volume is linked to genetics from the paternal mother and father.

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Although genetics is the biggest contributor to ASD, drug abuse in parents during pregnancy has been linked to be a cause in some cases.

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According to Autism Speaks has stated Boys are the four times more likely to be diagnosed with autism 

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It has been states males are more prone to have autism than girls. The ratio that has been consistent is 4:1 male to female when diagnosing autism.

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ASD is typically found by doctors by 18 months or even younger.

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Our group chose autism, more formally known as Autism Spectrum Disorder it is a neurodevelopmental disorder that effects how a person communicates, behaves, acts, and learns. We chose this topic because 1 in 36 children are found to be on the spectrum. With this large statistic being able to study and learn about this common disorder will allow us to have a better understanding of the disorder and participate in the CHS 100 class.

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This therapy involves specific sensory activities to adjust a child to light. This therapy also adjust children to sound, touch, smells, and other input. Furthermore, activities may be swimming, brushing, playing in a ball pit, and many other sensory- related activities. The result of these activities may may be better focus, improved behavior, and even lowered anxiety. This therapy is under occupational therapy.

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Although theirs no specific cause for Autism. Different research has shown that different genes might be involved with Autism. Some genetic disorders including Rett syndrome and X syndrome might be associated. Not only that but autism can run in the family since certain genetic mutations are inherited