Abnormalities of joint mobility and gait in children with autism spectrum disorders

  • Maya Shetreat-Klein
    The Division of Child Neurology of the Saul R. Korey, Department of Neurology, USA
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  • Shlomo Shinnar
    The Division of Child Neurology of the Saul R. Korey, Department of Neurology, USA

    The Department of Pediatrics, USA

    The Epilepsy Monitoring Unit of Montefiore Medical Center, USA
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  • Isabelle Rapin
    Corresponding author at: Kennedy 807, Albert Einstein College of Medicine, 1300 Morris Pare Avenue, Bronx NY 10461, USA. Tel.: +1 718 430 2478; fax: +1 718 430 8786.
    The Division of Child Neurology of the Saul R. Korey, Department of Neurology, USA

    The Department of Pediatrics, USA

    The Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx NY 10461, USA
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      Aims: Abnormalities of gross motor function in children with autism are well known to clinicians but have not received much empirical documentation and, with the exception of stereotypies, are not among its diagnostic criteria. We recorded the characteristics of gait and prevalence of toe walking, the range of passive joint mobility, and age at walking in children with DSM IV autism spectrum disorders (ASDs) and in age- and gender-matched typically developing peers (mean age 4 years 6 months, range 22 months–10 years 9 months). Methods: We evaluated maximum range of mobility at the elbow, wrist, metacarpo–phalangeal, and ankle joints and videoed children walking and running. Two neurologists blind to diagnosis independently scored features of gait clinically. Results: Children with ASDs had significantly greater joint mobility (p < .002), more gait abnormalities (p < .0001), and on average walked 1.6 months later than their non-autistic peers. Interpretation: This study indicates that attention should be directed to motor abnormalities as well as sociability, communication, and restricted and repetitive behaviors in individuals with ASDs. Motor deficits add to children’s other handicaps. They indicate that ASDs affect a broader range of central nervous system circuitry than often appreciated.


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        • Kanner L.
        Autistic disturbances of affective contact.
        Nerv Child. 1943; 2: 217-250
        • Kanner L.
        • Lesser L.I.
        Early Infantile Autism.
        Pediatr Clin North Am. 1958; 5: 711-730
        • Teitelbaum P.
        • Teitelbaum O.
        • Nye J.
        • Fryman J.
        • Maurer R.G.
        Movement analysis in infancy may be useful for early diagnosis of autism.
        Proc Natl Acad Sci USA. 1998; 95: 13982-13987
        • Lord C.
        Follow-up of two-year-olds referred for possible autism.
        J Child Psychol Psychiatry. 1995; 36: 1365-1382
        • Goldman S.
        • Wang C.
        • Salgado M.W.
        • Greene P.E.
        • Kim M.
        • Rapin I.
        Motor stereotypies in children with autism and other developmental disorders.
        Dev Med Child Neurol. 2009; 51: 30-38
        • Filipek P.A.
        • Accardo P.J.
        • Baranek G.T.
        • Cook Jr, E.H.
        • Dawson G.
        • Gordon B.
        • et al.
        The screening and diagnosis of autistic spectrum disorders.
        J Autism Dev Disord. 1999; 29: 439-484
        • Tsai L.Y.
        Brief report: comorbid psychiatric disorders of autistic disorder.
        J Autism Dev Disord. 1996; 26: 159-163
        • Rapin I.
        N Engl J Med. 1997; 337: 97-104
        • Mars A.E.
        • Mauk J.E.
        • Dowrick P.W.
        Symptoms of pervasive developmental disorders as observed in prediagnostic home videos of infants and toddlers.
        J Pediatr. 1998; 132: 500-504
        • Ming X.
        • Brimacombe M.
        • Wagner G.C.
        Prevalence of motor impairment in autism spectrum disorders.
        Brain Dev. 2007; 29: 565-570
        • Tuchman R.F.
        • Rapin I.
        • Shinnar S.
        Autistic and dysphasic children. I: clinical characteristics.
        Pediatrics. 1991; 88: 1211-1218
        • Rapin I.
        Neurological examination.
        in: Rapin I. Preschool children with inadequate communication: developmental language disorder, autism, low IQ. Mac Keith Press, London1996: 98-122
        • Haas R.H.
        • Townsend J.
        • Courchesne E.
        • Lincoln A.J.
        • Schreibman L.
        • Yeung-Courchesne R.
        Neurologic abnormalities in infantile autism.
        J Child Neurol. 1996; 11: 84-92
        • Nguyen A.
        • Rauch T.A.
        • Pfeifer G.P.
        • Hu V.W.
        Global methylation profiling of lymphoblastoid cell lines reveals epigenetic contributions to autism spectrum disorders and a novel autism candidate gene, RORA, whose protein product is reduced in autistic brain.
        FASEB J. 2010; 24: 3036-3051
        • Colbert E.G.
        • Koegler R.R.
        Toe walking in childhood schizophrenia.
        J Pediatr. 1958; 53: 219-220
        • Weber D.
        “Toe-walking” in children with early childhood autism.
        Acta Paedopsychiatr. 1978; 43: 73-83
        • Shulman L.H.
        • Sala D.A.
        • Chu M.L.
        • McCaul P.R.
        • Sandler B.J.
        Developmental implications of idiopathic toe walking.
        J Pediatr. 1997; 130: 541-546
        • Sala D.A.
        • Shulman L.H.
        • Kennedy R.F.
        • Grant A.D.
        • Chu M.L.
        Idiopathic toe-walking: a review.
        Dev Med Child Neurol. 1999; 41: 846-848
        • Accardo P.
        • Whitman B.
        Toe walking: a marker for language disorders in the developmentally disabled.
        Clin Pediatr (Phila). 1989; 28: 347-350
        • Rinehart N.J.
        • Tonge B.J.
        • Iansek R.
        • McGinley J.
        • Brereton A.V.
        • Enticott P.G.
        • et al.
        Gait function in newly diagnosed children with autism: cerebellar and basal ganglia related motor disorder.
        Dev Med Child Neurol. 2006; 48: 819-824
        • Vilensky J.A.
        • Damasio A.R.
        • Maurer R.G.
        Gait disturbances in patients with autistic behavior: a preliminary study.
        Arch Neurol. 1981; 38: 646-649
        • Ghaziuddin M.
        • Butler E.
        Clumsiness in autism and Asperger syndrome: a further report.
        J Intellect Disabil Res. 1998; 42: 43-48
        • Gillberg C.
        • Kadesjo B.
        Why bother about clumsiness? The implications of having developmental coordination disorder (DCD).
        Neural Plast. 2003; 10: 59-68