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Writing Study Ties Autism To Motor-Skill Problems

By Jon Hamilton

Published November 11, 2009 12:01 AM

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Many children with autism not only struggle with social skills and communication, they also have great difficulty with handwriting, according to a new study in the journal Neurology.

Researchers compared 14 typical children with 14 diagnosed with mild autism — and found that the children with autism had much more difficulty forming letters.

"It was really striking," says Amy Bastian, a neuroscientist who directs the Motion Analysis Laboratory at Kennedy Krieger Institute in Baltimore.

What Parents Already Knew

The finding offers scientific evidence of something parents have been saying for years, says Barbara Wagner, whose son Austin, 14, was one of the children on the autism spectrum who took part in the study.

Wagner says Austin's struggle with handwriting began when he got to first grade.

"He would have nights when it took three hours to do homework," she says. Austin is bright and understood the assignments, Wagner says. What was hard for him was the act of writing.

"He doesn't actually write like you or I would write," Wagner says. "He draws his letters. It was almost painful to watch."

And Wagner says things got even worse when he had to do written exercises in class. All the other students would be done, while he was still writing.

Things got better for Austin when he was diagnosed with Asperger's syndrome and his school allowed him to answer questions verbally, or type on a keyboard.

Motor Skills Linked To Communication

The handwriting issue on its own is a major impediment for many children with autism, Bastian says. But it's also indicative of a much larger problem with motor skills, she says. Many have trouble holding a fork, buttoning a shirt, or tying their shoelaces.

And these problems with motor skills may carry over into social interactions, Bastian says.

"These are the kids that are going to get picked last for kickball," she says. "These are the kids who are clumsy, who already have difficulty relating to other kids. And the motor component probably makes things worse."

Bastian says a lack of motor skills can also make it harder to communicate through subtle gestures and facial expressions. And people who can't make these gestures and expressions themselves often have trouble understanding what they mean when other people use them. The inability to read faces and gestures is a hallmark of autism.

Other researchers say motor skills may offer a way to help spot children with autism as early as the first few months of life.

A study of babies who were later diagnosed as autistic were late reaching milestones such as sitting up, standing on their own and walking, says Dr. Sarah Spence, a pediatric neurologist at the National Institute of Mental Health who helped conduct the study.

Spence says writing and all of these other skills rely on a process called motor planning, in which the brain gets itself geared up to carry out an action such as walking or talking.

So it's possible that some nonverbal children with autism actually want to speak, but lack the motor planning capacity.

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RENEE MONTAGNE, host:

Nearly all children with some form of autism struggle with social skills. A new study confirmed that many also have difficulty with an important motor skill: handwriting. NPRs Jon Hamilton reports.

JON HAMILTON: For Barbara Wagners son Austin, the trouble started when he got to first grade.

Ms. BARBARA WAGNER: He would have nights where it would take three hours to do homework.

HAMILTON: Austin was a bright kid. He understood the assignments. He knew the answers. Wagner says what was hard for him was writing them down.

Ms. WAGNER: He doesnt actually write like you or I would write. He draws his letters. It was almost painful to watch. It took that long.

HAMILTON: And Wagner says things got even worse when her son had to do written exercises in class.

Ms. WAGNER: This was something that Austin used to tell me all the time. Hes like, everybody else is done. And hes like, Im not done.

HAMILTON: Things got better for Austin, who is 14 now, when he was diagnosed with a mild form of autism. Thats when his school began to let him answer questions verbally or type on a keyboard.

There are a lot of kids like Austin who are on the autism spectrum and have trouble with handwriting. But scientists hadnt really studied the problem much until a group at Kennedy Krieger Institute in Baltimore set out to see whether kids with autism really did have worse handwriting than other kids.

Amy Bastian says her team got two groups of children to copy a sentence, then compared the results.

Dr. AMY BASTIAN (Neuroscientist, Kennedy Krieger Institute): We decided to start with a simple test, where you actually measure letters and you score letters based on some qualitative features.

HAMILTON: Like how big they are, how theyre spaced and whether theyre aligned. Bastian says they tested 14 typical kids and 14 on the autism spectrum, including Barbara Wagners son Austin.

Dr. BASTIAN: It was really striking how robust our findings were on this simple test. Kids really had trouble forming letters.

HAMILTON: Kids with autism.

Dr. BASTIAN: Yes. Yes.

HAMILTON: The handwriting issue on its own can be a big deal, but Bastian says its part of a whole other aspect of autism thats now getting attention, difficulties with motor skills. For many kids on the autism spectrum, she says, its hard to hold a fork, button a shirt or even play games.

Dr. BASTIAN: These are the kids that, you know, are going to get picked last for kickball. These are the kids who are clumsy, who have already difficulty relating to other kids, and the motor component probably makes things worse.

HAMILTON: Bastian says a lack of motor skills may even contribute to problems these children have communicating.

Dr. BASTIAN: You understand how someone else is feeling based partially on what theyre doing and how you feel when you do those same things. And so if you don't develop a normal motor sort of repertoire, then it may be harder for you to understand nonverbal communication from someone else.

HAMILTON: Researchers have only been looking at motor skills in autism for a few years, but theyve already found a range of subtle problems. And Sarah Spence of the National Institute of Mental Health says that could make it easier to spot very young children with autism. Spence did a study that found these children were slower to reach some key motor milestones.

Dr. SARAH SPENCE (Pediatric Neurologist, National Institute of Mental Health): Sitting up, standing on your own, walking, riding a bicycle.

HAMILTON: Spence says this new field of research may challenge some assumptions about children with autism who don't talk.

Dr. SPENCE: Some of those children may not want to talk because they have no interest in communicating. Some of them may have such cognitive problems that they really can't understand the concept of communication. But some of them may want to communicate and really just have the motor problem.

HAMILTON: The new research appears in the current issue of the journal neurology.

Jon Hamilton, NPR News.

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MONTAGNE: This is NPR News. Transcript provided by NPR, Copyright National Public Radio.

Source: NPR

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