Is there a Link Between ASD Motor Skill Deficits and Social Communication Difficulties?

I started this post thinking it would be about dyspraxia and Asperger’s. Dyspraxia, difficulty with fine and gross motor coordination, is often diagnosed alongside ASD. Adult symptoms of dyspraxia overlap with adult ASD traits to the point that even the experts have trouble separating the two. In fact, autistic individuals are sometimes misdiagnosed as dyspraxic.

If the experts are confused, I’m certainly not going to untangle the topic in a single blog post, so I decided to set that idea aside and write about general movement difficulties. Aspies are a notoriously clumsy lot. I’m forever tripping over stuff, bumping into stuff, dropping stuff, breaking stuff.

Seriously, if you like your stuff, keep me away from it.

I’ve broken an entire kitchen’s worth of glassware in my lifetime. In the first month of owning a new blender, I broke the glass pitcher not once, but twice. You’d think I would have learned the first time not to put it down so forcefully on the counter. After the second one shattered, I downgraded to a plastic pitcher because a blender is not worth that kind of trauma.

Gross and Fine Motor Impairment is Nearly Universal in ASD

The theories about why aspies are so uncoordinated are many: motor planning deficit, motor development delay, motor timing impairment, problems with initiation or inhibition, imitation and praxis impairments, deficient postural control, under reliance on feedforward control. There are also a handful of other conditions that muddy the waters further: apraxia, ataxia, hypotonia, dysgraphia, dyscalculia, dyskinesia . . .

You see where this is going, right? It would be easy to write a book on the subject and still not cover everything. Just defining all of those things would require a whole series of blog posts.

There are a few things that most of the experts agree on:

  • Some level of gross and fine motor impairment is nearly universal in people on the spectrum.

  • Motor impairments may improve somewhat with age, but generally persist into adulthood.

  • With more study, motor development delays could be a reliable indicator of the presence of ASD in very young children.

  • It is unclear whether dyspraxia is a separate diagnosis or the features of dyspraxia overlap with features of ASD.

  • The cause of motor development delay in autism is unknown.

It’s interesting that once again we have something (like insomnia) that occurs in the majority of autistic people but is not part of the diagnostic criteria. Autistic children routinely receive occupational therapy to improve their fine motor coordination, balance and posture; motor impairment is nearly universal. So why isn’t fine/gross motor skill impairment officially one of the diagnostic criteria?

What if Motor Impairments are Connected to More Than Clumsiness?

Some of the research I read about motor skill impairment in ASD is more radical than what you’ll find in the popular literature. Consider these two possibilities:

1. Delayed or nonexistent speech may be the result of a movement disorder. Rather than assuming that nonspeaking autistic individuals don’t have the cognitive development necessary for communication, some researchers believe that there is a physical impediment to performing the necessary movements with the mouth to produce speech.

This isn’t a blanket explanation for all situations in which autistic people are nonspeaking, but it does offer an alternative way of thinking about the relationship between speech and communication. Once we separate the two, thinking of speech in the physical rather than purely cognitive realm, we’re less likely to assume that because a person doesn’t communicate via speech they are incapable of communication.

lips

It also presents another way of looking at the phenomenon of “selective mutism” (temporary loss of speech). Often a temporary loss of speech in autistic individuals is related to a period of high stress. When I’m very stressed, my speech suffers and I can become temporarily mute or significantly impaired.

I also know that during periods of intense stress, I’m more likely to trip and fall while running or to drop things. There is a definite deterioration in my motor coordination under stress. It’s not hard to imagine this extending to the motor aspects of speech.

2. Social communication issues may arise from early difficulties with motor skills. Before children speak, they rely on nonverbal communication for play. If autistic youngsters aren’t modeling the expected nonverbal cues due to motor impairments, they will also fail to receive appropriate nonverbal responses from their peers.

This failure to communicate physically may mean that autistic children have fewer and poorer quality nonverbal interactions with peers and therefore struggle to learn social communication at the most basic levels. As they grow older and nonverbal communication grows more complex, they fall further and further behind.

Facial expressions, hand gestures, posture and body positioning–all physical movements–are the primary tools of nonverbal interaction. If autistic individuals have difficulties with initiating, performing, mirroring, inhibiting or planning physical movement, it stands to reason that this would include difficulties with the physical movements inherent in nonverbal communication.

eyes_boy

Social Communication Difficulties in a New Light

It’s interesting to think about social communication and speech difficulties as rooted in impaired motor skills. What if we struggle with speech and nonverbal social communication for the same reason that we struggle with catching a ball or learning to ride a bike?

Is it possible that a group of seemingly disconnected autistic traits have a common root in our motor skills impairment?

63 thoughts on “Is there a Link Between ASD Motor Skill Deficits and Social Communication Difficulties?”

  1. I absolutely love this perspective. It makes so much sense! I have three children on the spectrum. My oldest, has Aspergers, speaks quite well and is relatively athletic. My middle daughter is slightly more affected, more clumsy, and her speech is slower, although cognitively she is extremely intelligent and one of the best in her kindergarten class academically. My youngest is significantly delayed with gross and fine motor, ataxic, etc, and is completely non-speaking, though it is clear she is understanding us and is quite intelligent as well. So your theory certainly holds up in my family. This is excellent. Thank you for writing this.

    1. Wow, your children’s speech and motor skills seem very closely related. It’s interesting to see such a clearly delineated progression among them. I also love that you pointed out the lack of connection between fluent speech and intelligence. A lot of people seem to conflate the two. Thank you for leaving such a detailed comment!

  2. This is definitely something I can identify with. I’m verbal, but if I’m stressed my speech can go completely to pot (slurring, stuttering, mucking up sentence structures, and occasionally just plain nothing). I also had occupational therapy when I was a young child, mostly before I was diagnosed (age 9), so maybe the school thought I was dyspraxic at first, I don’t know.

  3. I sort of disagree with the social communication part of this. There are so many theories on potential mechanisms of allistic/autistic differences. I think, for social communication differences, motor issues may play a part but there are other more influential neurological factors. I’m diagnosed as dyspraxic, I’ve never had any assessment for autism although I am now in the process of seeking one. Something I have repeatedly come across while reading about both dyspraxia and autism is that in instances where autism-like traits (like communication issues) pop up in dyspraxia research or literature, they tend to be explained away with motor issues, while the exact same trait in an autistic person would be considered an aspect of their autistic neurology. I also know that a substantial proportion of the dyspraxic community is either diagnosed as being on the autism spectrum or suspect they might be. And, as you explained, even the experts can’t seem to decide where exactly the line is between dyspraxia and autism and what the common overlap they share. I feel like part of the confusion is caused by the fact that people aren’t acknowledging how wide this overlap is. I think a lot of dyspraxic people’s issues with social communication are arising from the same neurological differences as autistic people’s, and that may not have much to do with motor coordination. Maybe it would make more sense if many (though this doesn’t apply to all) cases of dyspraxia were considered to be ASDs.

    1. I think that a motor skills delay/impairment might be one part of the social communication picture. I also think that difficulty with eye contact, face recognition, information filtering, and a whole bunch of other things play into it too. The line between dyspraxia and ASD seems really murky. I agree with the explanation for the same traits being different depending on the diagnosis. I’ve seen that happen for other traits that overlap with other conditions as well. It’s all quite confusing.

  4. Wow. All I can say is wow. It reminds me of one of my boys. He babbled, making the same sounds over & over to communicate but because I couldn’t understand him we had problems. He now uses echolalia for the majority of his speech but what he says is mostly discernible. He has fine motor delays now but has mostly caught up with his gross motor skills. He has a lot of trouble with motor planning though. Just amazing to think of it that way.

      1. It does, yes, as well as many things you said here! Could you share which studies you saw that made the association? I research autism besides for being a self-advocate so I may have seen them, but I am always eager to see more studies.

        1. Sure, here are the primary resources I used for this post:

          The book “Stress and Coping in Autism” has a chapter titled “I Can’t Get Started: Stress and the Role of Movement Differences in People With Autism” by Anne M. Donnellan, Martha R. Leary and Jodi Patterson Robledo. This is the source of the hypothesis that speech difficulties may be primarily a motor problem. Someone has told me that you can the article/chapter online.

          “Current Perspectives on Motor Functioning in Infants, Children, and Adults With Autism Spectrum Disorders” (Anjana N. Bhat, Rebecca J. Landa, James C. (Cole) Galloway) is the article that I based the social communication difficulties section on.

          I hope this helps!

      2. Yes, thanks! Could you provide a PDF of the study by Drs. Bhat, Landa, and Galloway? I haven’t found access to it yet.

  5. Definitely some interesting, thought-provoking ideas here! Worth taking a look at and considering. I definitely had some gross motor skill issues as a young kid (the first time I crawled, until I learned to walk, I used to drag one leg behind me), and I’ve never been able to catch anything thrown at me, even when I can tell pretty much exactly where it would impact.

    Passing on to my SLP sister!

    🙂 tagAught

    1. Your sister is gonna be like who is this blogging chick with all these crazy theories?! 🙂 I was really intrigued by both of these ideas because they’re so different from much of what gets written about ASD and the causes of communication difficulties.

  6. The brain, the final frontier… (yes, the voice of Captain Kirk is playing in my head now!) There is SO much we don’t know, so the questions you propose here are intriguing and some of the connections you have made, well, I can see them at work in my son and even to a lesser degree in me. When I get overstimulated or overwhelmed it’s like my brain shuts down certain systems and I walk into doorways or drop what’s in my hand. Hmmm….

    1. I’m definitely much clumsier when I’m stressed or overloaded. Even my driving skills deteriorate. At least since learning about AS, I’ve realized that I need to be a lot more vigilant at those times.

      1. Dontcha just love awareness, I mean really. When we can shed light on something, anything, the difference at times can be stunning. Okay now, let’s see if I can stop walking into doorways now!!! 🙂

  7. I like your shift of perspective.

    When my youngest brother started in school, he had to be taken out again because (this is what the teachers said) he was ‘immature’. The teachers said that he did not pay attention in class, did not synchronise with what happened around him, they could not get eye contact with him, ‘it cost more energy to manage him than all the other kids together’ and his motor coordination was poor.

    They did have a solution, and this is where it becomes interesting: he had to delay school start and instead do a year in a special class called ‘language group’. The purpose of the class was to mature kids with a developmental delay to make them ready for school start. What is interesting was that the focus seemed to be almost exclusively on physical development: the kids were doing gymnastics and swimming a lot, possibly almost every day. We were advised to make use of any opportunity at home for motor coordination/balance enhancing exercises, any sort of sport or play that involved balance and motor coordination would help him. So any good chance to balance on things or catch balls et.c. was used…

    My brother was initially very upset about being separated from his peers from kindergarden and ‘put in a retard class’. My dad was angry and thought the teachers were a bunch of idiots who did not understand my brother and that their teaching was probably not interesting enough;-) but I think it has been very good for him. He was able to start school in a mainstream class after year, and has been doing well both academically and socially (well liked, have friends, no bullying) during his entire school time as far as I have heard. From his facebook, it seems that his main friends also started in that group (he has finished high school now), so maybe it gave him friends too (pre-school, he didn’t use to have any, apart from family). So the point is that the school targeted social developmental delay by targeting motor coordination deficiencies (and probably other things), and it seemed to work! So I guess that is a point in favour of the perspective that motor coordination deficiency is related to social and cognitive delay.

    Ps. Explanation for my brother’s delay: born 1 month too early, which has ‘slowed him down all the way’

    1. That’s really interesting that your brother’s “language group” focused so much on physical development. Do you know if the program is still in use? If there’s a website or some other information about it, I’m curious to learn more. It makes sense that he found his first and best friends in the class too, I guess, since it was a class for children who were all around the same developmental stage.

      1. I googled it and can see that it is a standard programme (free/subsidised) offered by Danish councils to preschool kids with delays in their language development, so there is plenty of information. I don’t know if that particular country town school still offer it, but I would think they do – since the need presumably always exists.

        Here and here (.doc) are a couple of links to councils’ official presentations of their language group programmes, BUT unless you can read Danish you won’t get much out of them.

        Generally, it seems that the programmes are individualised to each kid based on needs and goals for that child. – so maybe the strong focus on motor development in my brother’s case was simply his individual programme. The basic set-up of the groups seem to be that, besides the daily leaders/caretakers, the group has external professionals associated on a regular basis, such as speech therapist, psychologist, and physio therapist.

        Translated from the links:

        The language stimulation is based on the kid’s capabilities (resrouces) and takes place in safe and calm surroundings, through:

        Music
        Rhymes
        Drama (theatre)
        Motor activities
        Swimming
        Play with language, reading up, stories et.c.
        Individual work

        Above is quoted from Sproggruppe Hyldekaer

        The offer is for preschool kids, approximately 4 to 6 years old.

        The language groups receive kids who primarily have massive language difficulties, from all over Greve Kommune [Council area]. Difficulties include ‘impressive difficulties’ (to be able to understand what others’ say) and/or expressive difficulties (to be able to pronounce words correctly, and use them correctly).

        Language difficulties are often combined with other difficulties:

        Memory problems
        Motor problems
        Emotional problems
        Social problems

        That means the kids can find it difficult to

        Understand what they are being told
        Pronounce words correctly
        Find the right words
        Remember an instruction
        Use his/her body
        Coordinate moves
        Perceive other kids’ non-verbal cues
        Function in a group

        The above mentioned problem areas can be reasons a kid does not thrive and does not develop according to its age. Kids with massive language comprehension problems can be perceived as less intelligent or rude, which is not necessarily the case.

        […]

        Staff [shortened]:

        In each group, there are two language group pedagogues who work together […] There are always at least two adults present in the group. In addition, there is

        A speech/hearing therapist (always twice a week – work in the group plus with individual children, plus test the children)

        A psychologist (minimum once a month – test and retest individual kids when needed, evaluate the group’s social functioning and individual kids’ social competencies and opportunities)

        A physiotherapist (Ad hoc – observes individual kids and instruct how to work with each kid’s motor development)

        [… and importantly:]

        The kids are in the language group 3 days a week, a total of 12.5 hours per week per group. The rest of the time the kids remain in their kindergardens [my emphasis]

        Above is quoted from Sproggrupper [under Greve Council]

        So apparently, the Language Group isn’t a special class, it is an add-on programme that takes place in the school the kids are destined to go in but have not yet started in (because they are immature/language challenged), and they still spend the rest of their time in kindergarden. I think that may be why my brother was so upset – After spending the summer looking forward to school start and buying school start stuff and all that, after a few months they returned him to his Kindergarden:-) combined with a ‘retard class’. I see. I didn’t figure that out back then:-)

        1. Wow, thank you for translating all of that. That’s a really comprehensive and intensive intervention. It’s great to hear that it really worked for your brother. I think there are similar early intervention programs here specifically for autistic kids. Also, some parents will choose to voluntarily keeps kids in pre-K for an extra year if they don’t seem ready for Kindergarten. My daughter has a Nov. birthday and most of the boys with birthdays near hers ended up not going to Kindergarten with her because they needed the extra year of development.

      2. Hi, my comment ended in the moderation queue due to links:-) Can you fish it out?

        I forgot to mention that the quotes are of course my own translation of the sources I linked to, because I suspected that you and most of your readers do not read Danish effortlessly;-)

  8. Raising my hand to admit to serial breakages in the kitchen and like you, my clumsiness increases with stress.

    I don’t recall reading about motor impairments being a causal factor of impaired social intuition, but it makes perfect sense and I applaud your creative analysis.

    In fact, now that you highlight this, I am surprised that this hasn’t at least been acknowledged by the experts as possibly causal to impaired social intuition.

    It’s not like there isn’t a precedent for constructing theories on impaired social intuition!

    I also liked your point about motor impairments being absent from the autism diagnostic criteria.

    Thanks for sharing your perspectives.

    They are refreshing.

    1. There are a few articles that address the motor impairments-social communication link. The link between speech and motor delays is something I found in a book (Stress and Coping in Autism). Generally, though, these don’t seem to be very widely accepted views.

  9. Yes! My own motor skills and body awareness are particularly poor, to the point my body feels more like a vague sort of shape I float around in than a concrete thing with a shape and size and range of movement. I find the motor and proprioception (sense of where my body is in space and the shape it’s making) stuff far more disabling than the social aspect of autism.

    I’ve long held a theory that there’s a link between body awareness and motor skills and social skills. For instance, due to my poor proprioception I find it very difficult to mirror another person’s movements, for instance at an exercise class or learning to dance. I have a lot of trouble interpreting the shape another person’s body or face is making – which ties in to the classic autistic inability to read body language. I’m also usually to some extent unaware of my own body position unless I’m actually thinking about it. So if I’m unaware of the shape my body and face makes when I’m happy, sad, etc, how can I in turn recognise those shapes in others?

    1. I want to write another post addressing what you mentioned about the disconnect between body and senses. I often feel really uncomfortable in my body, like there’s no comfortable position for my legs or I don’t know what to do with my arms. The best solution I’ve found is wedging myself into a tight space to get some strong sensory feedback and quell the feeling that my limbs are going to float away.

      The mirroring issue is one that I came across quite a lot in reading about motor impairments. I’m horrible at imitating other people’s actions. Often I’ll feel like I’m doing exactly what the other person is doing but they’ll tell me that it’s not even close. So frustrating.

  10. When I was younger I would drop bowls of food and trip over stuff. Now I just spill things, esp. If I am tired or bump into the table when I get up off the chair. I am also known as the person who breaks wristwatches. Doesn’t matter how strong or sturdy it is, I am sure to break it eventually when I try to wear it within a year or two, when the rest of my family has kept their own watches for so much more than that. So my fine motor skills also have issues.

    1. It seems to be common for issues with motor skills to persist into adulthood, regardless of careful we try to be. I remember getting yelled at quite a lot as a kid for dropping and breaking stuff. (I guess my parents thought I was really careless.) At least as an adult, I can just clean up the mess without having to feel too bad about it.

      1. To this day, I will still glare at a bowl of soup I am holding and will it to stay in place! But now I can laugh at myself when it inevitably does fall.

        I definitely think that selective mutism, motor skills and the autism spectrum are related. A person might say some offhand remark to me that isn’t meant to be cruel. I think the comment can mean I’ve done something horribly wrong, but the person’s face indicates it’s no big deal. The mismatch of what I’m expecting as a reaction based on what I heard vs. the person’s calm expression will literally cause me to freeze up, because I don’t understand it. I will start to talk less and less, until i completely go mute. Then, when I start to get back to a less stressful state, I do find myself a lot less coordinated than usual. Even talking doesn’t feel quite right. Has this happened to anyone here before?

        1. Just last night I went to reach for my mug of tea and spilled it all over my husband’s takeout sushi. He just looked at the mess and mumbled something about my motor cortex. 🙂

          I tend to lose speech in highly charged emotional situations too. And I definitely see a relationship between an episode of muteness and a period of increased clumsiness afterward. Two specific occasions I remember because I took bad falls while running the day after I’d had a episode of lost speech. I’m curious too to know if anyone else has noticed a link between the two.

      2. musingsofanaspie, how were you able to deal with highly charged emotional situations so that you don’t lose speech as often? I’ve learned from close family that this “breakdown” frightens them, because I become completely quiet: my voice, my personality, my expressions, everything shuts down. At times, I even look angry to them before I become mute. And I can definitely see where it might be frightening to relationship partners or co-workers.

        1. Honestly, I haven’t found a good strategy for this. I recently had a difficult conversation with family members and ended up mostly nonverbal and people were hurt because of my silence. I’d do anything to overcome that but it’s still very much a mystery to me how. The shutdown you describe, where you just sort of “go away” is what I experience at times too. It’s frustrating! I wish I had a brilliant answer for you. 😦

      3. Are you able to write when you shut down? When I was a kid, my stutter made it hard to communicate, and I lost speech more often to boot. I’d carry around notepad and pen and write stuff out rather than deal with the humiliation of having people bug me with “spit it out,” and “just say it,” and “why are you stu-stu-stu-stu-stuttering?” I wrote the explanation for why I was writing on the front page of the pad so I could always find it easily. “I’m writing because I can’t talk right now.”

        And I’d write really slowly because my handwriting is awful if I don’t write slowly, but even still, I could communicate faster that way than without it. Rather than trying to force speech I couldn’t produce, I went around the problem. Would that work for you?

        1. In full shutdown, I don’t think I could write. Generally if I shut down, it’s related to a highly emotional situation and my ability to communicate at all goes over a cliff. But I’m going to see if it’s possible next time it happens. I hadn’t ever thought of trying before so it might be something I could use, at least to explain why I’ve gone nonverbal or nearly so.

  11. This makes a lot of sense. I have poor spatial awareness and am clumsy, I’m always walking into things. I feel like the reason I find communication hard is because I can’t judge when it is my turn to speak. It feels exactly like when I try to cross the road: overwhelming!

    1. I have a lot of trouble judging when it’s my turn to speak too, so I interrupt people a lot. Apparently, vocal inflection is a signal for turn taking in conversation, but it’s not one that I pick up on all the time.

  12. Was never diagnosed dyspraxic, but in addition to having asperger’s I am also dysgraphic, and since most of my dysgraphia is motor and some spacial, you know there is something going on their coordination-wise.

    1. It seems like there is a really high incidence of dysgraphia with Asperger’s. I consistently got bad marks in handwriting/penmanship all through elementary school, though I don’t think my difficulties are enough for a formal diagnosis of dysgraphia.

  13. When I was a kid, my parents nicknamed me “rabbit” because of the awkwardly bounding nature of my run. It was also a bit of a joke because I definitely was not quick. I couldn’t throw a ball in vaguely the direction I wanted it to go until I was 12, didn’t learn to ride a two-wheeler until 9, though my father started teaching me at 5, and I was forever falling and hurting myself. And I still can’t bat. Don’t ask me to bat. My batting average is I’ve hit a ball 3 times since I was 11 and that’s despite a gym class that spent three months on baseball every year through school. I was the kid exiled to the edge of the field to practice batting every gym class, then occasionally dragged in front of everyone for a dose of gym teacher humiliation because I couldn’t just genuinely be spectacularly awful at batting, it must be because I wasn’t trying hard enough.

    I drop stuff a lot, especially if I’m concentrating on other stuff. I do roleplaying games and if I don’t drop my dice at least four times in the night, it was a good night. I’ve mastered the art of the jump back to get my feet out of the way of the heavy ceramic cup I just dropped. Also: I never buy glass. Only ceramic or plastic. Glass will be broken within two or three months, and I’ll probably step on a shard just to add insult to injury. I’m not easy on my stuff at all.

    And I lose speech when stressed or upset. If I’m lucky, I just have my childhood stutter come back. If I’m not, my syntax starts screwing up and I start mixing up words for other words that either have the same root (sense, sensible, and sensitive, for example) or make no sense to use unless you’re me. When this happens, I’ll usually try to just answer nonverbally as much as possible. If I’m really upset, I can’t talk at all unless I write it out and then read what I’ve written (assuming I can read my handwriting, which is infamous as the worst writing in my workplace!). Though, I can think of what I want to say, getting it out my mouth is the hard part.

    1. I’m pretty good with throwing and catching. One of my favorite passtimes (stims?) was throwing a tennis ball at the wall and catching it repeatedly. Then again, in middle school I spent about 5 minutes playing shortstop on the school’s softball team. My “tryout” promptly ended when I caught a line drive with my face, breaking my glasses in the process. I spent two seasons playing right field because few balls ever got hit there. I think the team just needed enough girls to field a full team and not get disqualified at games. 🙂

      That feeling of knowing what to say and not being able to form words is so frustrating. I’ve never tried writing out my responses when I’m nonverbal. That might be a useful option if the other person was willing to be patient enough.

  14. Speech delays, echolalia, fine and gross motor delays, toilet training at age 5, no proprioception, clumsy running and not riding a bike until 12, super memory, dysgraphia and dyscalculia, literal sense of understanding conversation – a diagnosis of Asperger’s at 2nd grade (7). Now only in speech therapy, has learned to start conversations with other people with 2 lead-ins: Do you have any pets? and Have you seen “The Exorcist”? That’s it.

    1. Oh gosh, is it terrible that those conversation starters cracked me up? Honestly, I don’t think I have any stock conversation starters. Unless someone initiates a conversation with me or I specifically need to do or find out something, I’m content with silence.

  15. Sorry for taking so long to reply to this, annoyingly I seem to have left it so long that the half-written response I wrote has been lost.

    I’m really glad to see the movement/coordination/clumsiness aspects of the autistic spectrum being looked at in detail, I’ve noticed that outside of the UK there seems to be very little awareness of this. In the UK there seems to be much more awareness of the extent of impairment that coordination differences can cause, however this seems to tend to be seen as a discrete thing called ‘dyspraxia’ and somehow separate to the rest of autism. I’d prefer that these traits be seen as autistic, but I think on balance awareness with caveats is better to being almost entirely oblivious.

    In my opinion movement and coordination differences are core to autism. Also in Hans Asperger’s opinion; clumsiness was one of the criteria for his syndrome, common to all his patients, and it was in the draft version of the DSM-IV criteria until ‘the last minute’.

    However I’m hugely suspicious of any theory of autism that takes one single trait and says ‘this is the cause of all the other traits’. I’ve read theories that argued sensory differences account for all the other traits. Under this theory movement difficulties are down to proprioception, vestibular and visual sensory differences. I’ve also read theories saying that difficulty prioritising (or a difficulty arranging parts into conceptual wholes, or a difficulty forming masking concepts and metaconcepts) causes everything; this shifts movement problems to being a planning difficulty. And I’ve read theories saying that it’s all due to extreme specific learning differences, that movement problems are then due to only having strong verbal, visual or pattern matching skills and using these to perform every other task. Etc etc!

    I think in reality all the different traits have pervasive impact and so interact with each other in a complex interconnected system. No one trait accounts for everything and can be taken as separate from the others.

    Of course being clumsy and having poor awareness of ones body doesn’t exactly help with fitting in socially when you’re growing up, but clumsiness itself doesn’t account for sensory processing differences, working memory differences, processing speed, executive function, concentration difficulties. The fact all those tend to go together implies that they’re all caused by the same thing or part of the same condition, rather than that the particular trait that is most obvious, clumsiness, causes all of them. I think it’s also important to remember that there are people who have dyspraxia/DCD diagnoses, sometimes with some extremely severe movement impairments, who don’t show the other traits of autism.

    As for the effects of movement differences on speech; Developmental Verbal Dyspraxia is a commonly recognised (well, in the UK at least) impairment that can go along with general dyspraxia or be a separate condition. I have various mispronunciations that get worse when I’m tired. None that were bad enough to get me sent to a speech therapist, but enough to associate my inability to say things properly with my difficulties with movement, posture, holding a pen, tying shoelaces etc etc. I tend to put ‘s’ sounds on the end of words that end with ‘t’, pronounce ‘th’ as ‘f’ and generally say things in a ‘mushy’ way if I don’t concentrate on speaking clearly. This contributed to my dyspraxia diagnosis, which contributed to my diagnosis with Asperger’s.

    So, in conclusion, I’m saying that movement differences can most definitely have a profound and pervasive effect, but that this doesn’t meant that they (completely) cause or account for the other traits of autism. The other traits of autism are also profound and pervasive and would have significant influence on the ability to plan, produce and sense movement. Also this is a brilliant post and I hope that more of the autistic community will be spreading awareness of movement and coordination traits!

    1. I completely agree with you about no one thing being responsible for all ASD traits. But I was intrigued by these different way of looking at things that are routinely assumed to have psychological or cognitive roots.

      In some way I think there’s a lot of resistance by psychologists/psychiatrists to the idea that ASD might have major physical/physiological components. Look how long it took to include sensory sensitivities in the diagnosis, though nearly everyone with ASD experiences them. Same for sleep difficulties and motor skill impairments. ASD isn’t the only “syndrome” that gets this kind of treatment. PTSD is also increasingly be approached from a neurobiological viewpoint than a purely psychological viewpoint. It seems almost as if psychologists and psychiatrists are afraid of the neurology folks encroaching on their turf at times.

      Gah, I’m feeling cranky tonight.

      1. I think you’re absolutely right there, and the entire system is extremely conservative when it comes to widening or changing definitions. It’s an extremely slow pace with incremental changes happening over decades.

  16. Just adding my little insignifiant comment after a while, I wanted to say something :D. I’m clumsy as possible, never been able to ride anything, from rooler-blades to skateboard or anything. Even skying, it’s like I’m literally going in the snow and the tree instead of the path. My legs are full of bruises from hitting myself on the corner of the desk at school, etc. And although I’m verbal, and often speak way too much, whenever I’m stressful, my speech do tend to become messy, just like my motor skills, and I can also drop to the level of not being able to actually speek when I’m really stressful (final exam, unplanned trip, unknow destination without time, food, bag, cloth, toilet and nobody I know…… ) And have to rely on basic sign communication.

    When I read the title of this post, I was like : I don’t know if it’s true, but hell, it is for me!

    1. Based on the comments it looks like it’s true for many of us.

      I went skiing once and fainted during the lesson. 🙂 It was a disaster. And I’m constantly crashing into the corners of things. I’m sitting here right now with my two smallest toes on my left foot throbbing because a minute ago I got up to turn off the printer and hooked my toes on the corner of my desk. The fun never stops! 🙂

  17. I have trouble with talking when stressed as well; especially when speaking to a group and they all start looking at me expectantly. My mind goes blank, I start saying the wrong words and I completely lose my train of thought. Another thing that makes my speech clumsy is sugar. Whenever I eat a piece of cake, or a candy bar, or any other sugar-y treat (pop, ice cream, etc.) I cannot speak straight for several days afterwards.
    And I run into things a lot; I’ve actually knocked myself out running into my door jam, and then nearly knocked myself out again running right into a wall. Yeah. And stress augments my clumsiness as well; I can’t catch anyway, so when I’m stressed I just start dropping things left and right, I can’t remember where I put stuff, I lose my balance at the drop of a hat – my mom’s about the same way though she’s never really diagnosed herself anything.
    Very informative post, I really liked it.

    1. That’s interesting about how strongly sugar impacts you. A few years ago I cut way back on my sugar intake and found that my moods became a lot more stable. I don’t know if it affected my functioning in other ways because I had no idea about autism at the time. I definitely felt more settled overall though.

      1. Yeah, removing the sugar helped stabilize my moods as well; my sister and I get along much better now, whereas before we were almost always bickering or fighting.

  18. Hi, I’ve been diagnosed with dyspraxia. I had coordination problems when I was younger but they weren’t that serious not as bad as some of you here with Asperger, and I’m the one with dyspraxia. I do have some theory of mind, and I do feel sad if people are sad but I struggle much more and always have, with the social aspects of whatever is in my brain. It’s not easy for me to figure out how people think and that involves lots of processing. I’ve had more experience. I find eye contact difficult. My coordination difficulties are mild but I’ve been told that I have empathy and enjoy reading fiction and fantasy so I don’t have Asperger. So I’m very confused now. I really can’t see what differences there are between my symptoms and the female symptoms of Asperger. I’ve asked for an explanation from the doctor who said this and he just babbled on. And for the social issues, I’ve been told to speak with the National Autistic society for help.

    1. I have a lot of difficulty understanding how doctors decide whether to give a dyspraxia dx or an AS diagnosis because there is so much overlap. It does sound like you have a lot of traits of Aspergers. Perhaps getting in touch with the NAS might be a good idea. You could explain that you seem to have symptoms beyond the dyspraxic symptoms and would like to get re-evaluated by someone who is experienced in diagnosing adult women. It may not be possible, but it’s worth a shot.

      1. It’s what type of doctor or specialist you see – if you go to an educational psychologist they can only assess things measured quantitatively so you’ll end up with the specific learning difference that fits your cognitive profile and a label like dyspraxia or nonverbal learning disability. An occupational therapist might give you a diagnosis based entirely on sensory issues. Similarly a mental health specialist might give you a diagnosis of depression and social anxiety, but not consider the social and situational pressures that cause those to arise (being unrecognised autistic). If you go to an autism specialist, they’ll give you a different diagnosis for the same traits, this is probably the most important label, but the others are important issues too. No one really assesses for and considers all of them together – although holistic services like my local Asperger Service are now trying to.

        I attended, live blogged and Storified a talk by Nottingham City Asperger Service’s Specialist Psychiatrist that went into some detail about this – it’s like the old fable about explaining what an elephant is when only examining one part of it:
        http://graphicexplanations.info/2013/10/08/nottingham-cafe-sci-thinking-about-neurodevelopmental-conditions-in-adulthood/

    2. Your doctor doesn’t know what he’s talking about, science fiction and fantasy conventions are full of autistic people, many of which are the authors. Also we don’t tend to lack empathy, as in feeling upset if someone else is upset, it’s more that we can miss that people are upset if they’re not saying so or displaying it clearly. If anything, I can find other people’s emotions too overwhelming.

      I too had a dyspraxia diagnosis for 5 years before I was able to get assessed for Asperger’s, despite the majority of my problems being social or executive function. What you’re describing sounds just like me and I have an Asperger’s diagnosis now. I have several other friends who had similar experiences of getting a dyspraxia diagnosis first and that acting as a block on having a full diagnosis.

      One of the complications with working out if you’re on the autistic spectrum when you have a dyspraxia diagnosis is that a lot of the dyspraxia resources were written by people who later got an AS diagnosis – Caged In Chaos, for example, is by someone who was later diagnosed.

      If you’re in the UK then already having a dyspraxia diagnosis and having social difficulties means that your GP should refer you to an autism specialist for assessment for an autistic spectrum condition. The NICE pathway for autism set by the UK health regulator makes it clear that this is enough to move you past your GP’s gatekeeping and on to someone who actually understands AS.

      1. That is incredibly interesting. It was because of Victoria Biggs that I was eventually disagnosed with dyspraxia because of how well I related to her social issues. I assumed all she put on there was related to dyspraxia, said that’s me, and I was diagnosed. She discussed a lot of the social aspects which is what I was and still struggling with. It would explain why I got so confused when there wasn’t as much focus on the social aspects of dyspraxia but most of the focus was on the motor problems which I wasn’t having much trouble with, in my research. Good God!

        Where could I find the NICE pathway specifically regarding dyspraxia then autism?
        I was wondering if I could contact you privately. I understand if you are not able to.
        Thank you so much. This has really helped and explains a lot.

        1. Yes, that’s just what happened to me, IIRC she was diagnosed within a year or so of the book being published too, so it’s pretty irresponsible that JKP have continued to publish it for years since without explaining that it’s about someone who doesn’t know they have Asperger’s yet. I was scandalised when I found out from her website (no longer active but a relevant part of it is archived as the second list item here: http://wikiworldbook.com/global-address-book/Victoria-Biggs#web-results ), because it meant that book had held back my self-understanding for years.

          There’s a new edition coming out next month, which does have Asperger’s relevant tags on the JKP site, so it’ll be interesting to see if it’s been re-written to make the social aspects more clearly autistic traits. I hope so, it’s a genuinely great book if you understand that it’s a combination of dyspraxia and autistic social issues and executive function. Terrible if you’re using it to understand dyspraxia on its own.

          Dyspraxia has such an overlap with the autistic spectrum, and so many autistic adults only manage to get a dyspraxia diagnosis that the Dyspraxia Foundation’s adult symptoms list are also extremely misleading in how all encompassing they are. They include all the traits of all the neurodevelopmental conditions that might overlap with dyspraxia, but without explaining that these aren’t strictly dyspraxia traits. It was very useful to me back in the day for getting Disability Discrimination Act reasonable adjustment at work for Asperger’s traits, without actually having a diagnosis of that, but otherwise stopped me from recognising that dyspraxia really didn’t cover my traits at all.

          The Wikipedia page for dyspraxia used to be the same symptom list but with a separate list for everything that wasn’t dyspraxia but actually a trait from overlapping conditions. I found that very useful at the time. These days it’s shrunk down to only listing fine and gross motors coordination and working memory as core traits, gives a section on how common overlap with sensory issues is and then everything else is simply a list of related conditions with links to their pages.

          The National Autistic Society have a really helpful page defining what different labels actually mean here:
          http://www.autism.org.uk/labels

          I had briefly got stuck at ‘Nonverbal Learning Disability’ after dyspraxia, having learned that it’s what the social side of dyspraxia would be diagnosed as in America, and that my WAIS cognitive profile would qualify me for a diagnosis without further assessment. At the time it was being explained as like milder Asperger’s but with a different cause, so seeing the NAS saying that it’s a subset of Asperger’s as far as they’re concerned was hugely helpful for getting me past the ‘barrier’ too. Honestly, actually having an accurate diagnosis and help from specialists in the right area has made a huge amount of difference to me.

          As for the NICE pathway for autism, it’s here:
          http://pathways.nice.org.uk/pathways/autism#path=view%3A/pathways/autism/identification-and-assessment-of-autism-in-adults.xml&content=view-node%3Anodes-identification-and-initial-assessment

          The relevant part is:
          Consider assessment for possible autism when a person has:
          one or more of the following:
          – persistent difficulties in social interaction
          – persistent difficulties in social communication
          – stereotypic (rigid and repetitive) behaviours, resistance to change or restricted interests
          and one or more of the following:
          – problems in obtaining or sustaining employment or education
          – difficulties in initiating or sustaining social relationships
          – previous or current contact with mental health or learning disability services
          – a history of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder.

          If you’ve scored more than 6 in the AQ-10 then you’d be meeting all three of their criteria.

          The entire NICE guidance is online in various forms here:
          http://www.nice.org.uk/CG142
          Relevant web page here, section 1.2.2 and 1.2.3:
          http://publications.nice.org.uk/autism-recognition-referral-diagnosis-and-management-of-adults-on-the-autism-spectrum-cg142/guidance

          As for contacting me privately, I’m pretty terrible at responding to emails and tend to miss Facebook messages but we could have a go if that would be useful. I don’t mind continuing to write long messages here so people using search engines can find them in the future 🙂

          1. Thanks so much for your help. Is there awareness amongst professionals who diagnose autism that many people with autism are diagnosed with dyspraxia instead?
            I’ve been referred to the autism service now by my GP. It will only take 18 months to see someone :-/

            1. Glad to help!

              In the UK at least, having a pre-existing SpLD (dyspraxia, ADHD etc) or mental health diagnosis is considered one of the three things that NICE recommends are meant to get you referred to be assessed for autism, along with an AQ-10 of 6 or higher and social/relationship/employment difficulties.

              Professionals who diagnose should be very familiar with this. GPs and other frontline staff, probably not so much.

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