We often think of those with autism plus reliable speech and those with autism plus unreliable or no speech to be on the same spectrum—similar challenges and those with nonspeaking autism are assumed to have additional cognitive and receptive language problems. However, these are two different populations because nonspeaking/unreliable speaking autism has a concomitant severe sensory motor disorder. Developmental Coordination Disorder (DCD) is a chronic motor skill disorder characterized by poor gross and fine motor performance, poor balance, incoordination, and difficulty with initiation, continuation, and cessation of movement. Physiotherapy is one of the cornerstones of treatment for the condition. Praxis is the process of deciding what the body has to do and then doing it; the ability to conceptualise, plan, and organise movements in order to complete unfamiliar motor tasks. Dyspraxia is a term given for having problems with praxis. “Dyspraxia”, “full body apraxia”, “motor planning apraxia” and “DCD” are often used interchangeably by clinicians, as noted in the current revision of the DSM-V Manual, and has replaced Dyspraxia with DCD. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter-professional communication and getting a diagnosis.

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Multiple recent studies have shown evidence of the co-occurrence of autism plus DCD. Miller et al (2021) noted that over 90% of cases in the autism study group met criteria for co-occurring, concluding that DCD motor challenges are a clinically- significant problem in autism and that systematically assessing the prevalence of co-occurring autism + DCD is necessary to optimize assessment and intervention. Some have even argued the case for adding “motor challenges” to the definition of autism (Bhat 2020). These motor challenges in autism have been shown to predict social communication delay, language delay, functional delay, and repetitive behavior severity even after accounting for intellectual disability or cognitive delay (Spark study).

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When a child cannot communicate their challenges with motor planning yet understand the task given to them, a misdiagnosis of low IQ and/or receptive language delay is often given. These are also tend to be the children with autism who have either no or unreliable speech. However, a variety of motor impairments are present across the entire spectrum of children with autism, regardless of their IQ scores. Both, fine and gross motor performance are significantly correlated with IQ but not with autism severity; however, praxis errors (mainly, total, overflow, and rhythmicity) are strongly correlated with autism severity and not IQ. This highlights the need for clinicians and therapists to include motor evaluations and interventions in the standard-of-care of children with autism commonly assumed to automatically have low IQ.

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Despite motor impairments being pervasive in Autism, the dual diagnosis of DCD plus autism is rarely given. In Canada, “Level 3 Autism” automatically triggers a referral to SLP, OT (primarily for sensory management), and “behavioral therapy”, typically provided from an Applied Behavioral Analyst (ABA). This is also true for the US; Bhat et al (2020) found that about ~80% of children with ASD in the SPARK study received speech and OT interventions that mainly address their communication and sensory processing problems but no physiotherapy to address gross motor challenges.  Policy and practice lag behind in recognizing the potential contributions of physical therapists in research, practice, and education, yet Physical therapists have the potential and ability to play a much greater role in autism. The current body of research suggests that motor difficulties in autism are quantifiable and treatable, and that detection and intervention efforts targeting motor function may also positively influence social communication. Compromised motor function requires increased attention, leaving fewer resources available for processing environmental stimuli and learning. This knowledge suggests that the motor system—which we know to be trainable—may be a gateway to improving outcomes of individuals living with autism.