Mysteries of Motor Abilities in Autism

And what I'll say, Alicia, as you said, I focused in on this system of motor.

And what I'll talk about is that I mentioned the pediatrics, the pediatric neurology training.

What's interesting is that in typical pediatric neurology training, I had a lot of exposure to autism.

But actual sort of discussion about what autism means, how it presents, how we diagnose it, how we support it, to be honest, happened less so in pediatric neurology training.

And that's something that we've actually separately been working on addressing quite a bit and has really improved over time.

But it was in my neurodevelopmental disabilities training here at the UCLA Center for Autism Research and Treatment where I was really enveloped every week in taking care of children with autism.

And of course, I was asking things about how do they communicate? What's their language like? What are their repetitive behaviors? But one thing that I noticed in almost all the patients that I saw was that they had some level of difficulty with their movement or their motor skills or their motor milestones.

And I'll never forget going back to some of my mentors here and saying, well, have you ever seen that? Like, how come we don't talk about that all the time, right? Because as a neurologist, we're trained to look at movement.

We are trained to identify that looks different.

So first we describe the semiology.

That means how does it look? Somebody looks ataxic or wide-based or wobbly.

And then the next thing we're trained to do is localize.

Where is that coming from? And we do that because it helps us diagnose and it helps us treat.

So localized would mean you're ataxic, you're wobbly, you have a wide-based gait.

OK, something's going on in your cerebellum or the pathways leading to the cerebellum.

You have short steps.

You're slow.

You're shuffling.

Something is going on with the striatum or the pathways that lead to the striatum.

But when I started seeing this in all the kids and all the motor areas it was impacting and I started looking at the literature and clinical data, what I saw was that doesn't really exist very well in autism.

And that really struck me.

And it struck me not only because of the prevalence of motor impairments or motor difficulties that we saw, but the fact that it existed in many motor domains.

So fine motor skills, the sort of precise movements that you use, how you use your hands, how you grasp.

Gross motor skills, so things like balance, walking, coordination, adaptive movement, feeding yourself, dressing yourself.

And not only the prevalence across these domains, but how much it was impacting other aspects of development, which we can talk about as well.