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Clinical and Research considerations for Autism Screening, Assessment, and Diagnosis in conditions with Early Onset and Severe Motor Impairments

April 8, 2025 from 1:30 pm to 2:50 pm

While motor impairments were not central to historical conceptualizations of autism, accumulating literature indicates various difficulties with motor coordination (e.g., odd gait, clumsiness, other abnormal motor signs) in autistic individuals across a lifespan. Conditions with early onset and severe motor impairments are often highly associated with autism spectrum disorder (ASD). These conditions include cerebral palsy (CP) and many neurogenetic conditions considered to be caused by high-confidence ASD risk genes. However, the presence of significant motor impairments can both influence social communication abilities (e.g., ability to gesture, look, reach) and impede the ability to use the most well-established screening and diagnostic measures for ASD. There is a need to better understand (1) how motor impairments were first considered when creating and operationalizing ASD diagnostic criteria, (2) how the presence of motor impairments can affect the manifestation and measurement of ASD symptoms, and (3) the clinical judgments made around ASD diagnoses in conditions with early onset and severe motor impairments. In this symposium, we share insights on these clinical and research-relevant topics from three different diverse studies of motor impairments in ASD, genetic neurodevelopmental conditions (chromatin modifying conditions), and CP. We start with a description of the motor requirements in current ASD diagnostic instruments and the motor skills in the validation samples for these instruments as well as large-scale data on motor profiles of children referred for ASD evaluation. We will discuss the use of ASD diagnostic tools for children with genetic neurodevelopmental syndromes and our findings on a study of autism symptoms and motor profiles in these children compared to those with non-genetic ASD. Lastly, we will present the results of an international survey on professionals’ perceptions on the challenges and appropriateness of assessing for ASD in individuals with CP and other early onset motor conditions. Investigation into motor impairments in ASD and ASD related conditions, particularly how they impact the use of standardized diagnostic tools and shape ASD symptomatology is critical in informing clinical care and research practices in these conditions. Ultimately, these data can inform diagnosis, management, and the development of personalized therapeutic strategies for children with ASD and primary motor impairments.

Chair: Rujuta Wilson, UCLA David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior,

Discussant: Audrey Thurm, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

First Presentation: Motor profiles in children with autism spectrum disorders
Somer Bishop, University of California, San Francisco, Lindsay Olson, University of California, San Francisco
Aaron Kaat, Northwestern University
Shuting Zheng, University of California, San Francisco

Second Presentation: Examining motor and autism phenotypes through direct and objective assessment in genetic neurodevelopmental disorders
Rujuta Wilson, UCLA David Geffen School of Medicine, Sereen Wong, Ronald Ly, Nicole M. McDonald, UCLA David Geffen School of Medicine
David Elashoff, Sitaram Vangala, UCLA Department of Medicine Statistics Core

Third Presentation: Autism Spectrum Disorder assessment in people with Cerebral Palsy: perspectives of professionals from an international survey
Olga Laporta-Hoyos, Universitat de Barcelona, Barcelona, Spain, University of California, San Francisco, USA