Lorna Jean King is one of the pioneers of sensory integration therapy. She was the founder of The Children’s Center for Neurodevelopmental Studies in Phoenix Arizona and was a close friend of Bernard Rimland, Jean Ayres, and Margaret Creedon. Lorna once said that most people with autism spectrum disorder (ASD) have a form of cerebral palsy (CP). She based her statement on her own observation that for some teenagers and adults in the autism spectrum, their arms would raise involuntarily when they ran. This motor behavior was exacerbated in adulthood and not readily apparent when they were children. Steve Edelson, Director of the Autism Research Institute (ARI), has also wondered whether such a connection could explain some minor motor movements observed in ASD.

Cerebral palsy is a group of permanent movement disorders caused by damage to the brain, more specifically, those parts that control movement, balance or posture. Besides movement disorders a significant number of individuals with cerebral palsy also manifest epilepsy, learning disabilities and problems in communication. Furthermore, for reasons not readily apparent, cerebral palsy is also more common among boys than among girls. All of these symptoms are reminiscent of ASD. It is therefore not surprising that according to epidemiological studies approximately 7% of CP patients have co-occurring ASD (https://www.cdc.gov/ncbddd/cp/features/prevalence.html) (see also Christensen et al., 2013). This association is further supported when one realizes that the prevalence of ASD among children with CP is significantly higher than among those without cerebral palsy: 7% vs. 1% (CDC, 2012).

Recently scientists from Routgers University have reported that micro-movements may be a core feature of ASD (Torres and Denisova, 2016). The study was based on an MRI time series of 1048 participants that examined head motion. These micro-movements are involuntary, occur without the patient’s knowledge and regardless of medication usage, IQ, or ASD severity. I found the research and results somewhat contrived because ASD individuals usually find it harder to stay still while in an enclosed MRI machine.

It is interesting that the authors targeted potential avenues of funding by repeating their mantra of Precision Medicine but gave little attention, if the same was true, to the possible biological basis of their observed phenomenon.

Several studies have shown that ASD individuals suffer from dyspraxia (i.e., a loss in the ability to coordinate movements). Motor planning is defective in this condition and is usually manifested as clumsiness in walking or running, and impaired hand writing and imitation skills. In many cases the dyspraxia is the result of an immature organization of motor pathways and tends to improve. In previous decades, the condition was called Clumsy Child Syndrome, but its pejorative connotation has led scientist to revert to the Greek nomenclature. Early indications that a child may have dyspraxia include (http://www.dyspraxiausa.org/symptoms/early-symptoms/):

• Irritable and difficult to comfort from birth
• Feeding difficulties: milk allergies, colic, restricted diet
• Sleeping difficulties: problems establishing routine, requires constant adult reassurance
• Delayed early motor development: sitting unaided, rolling from side to side: do not usually go through the crawling stage
• High levels of motor activity: constantly moving arms and legs
• Repetitive behaviors: head banging or rolling
• Sensitive to high levels of noise
• Continued problems with development of feeding skills
• Toilet training may be delayed
• Avoids constructional toys such as jigsaws and Lego
• Delayed language development: single words not evident until age 3
• Highly emotional: easily distressed, frequent outbursts of uncontrolled behavior
• Concentration limited to 2 or 3 minutes on any task?

Dyspraxia can affect many muscle movements including those of face and mouth. Although the dyspraxia may be obvious when the individual attempts to talk, it may also be noticeable (to a lesser extent) when the individual is at rest. This may lead to repetitive behaviors, irritability, an inability to stay still, but maybe also to the involuntary movements observed by the Routgers scientists.

When deep masses of grey matter are affected in the brain (i.e., basal ganglia) cerebral palsy can give rise to involuntary movements called dyskinesia. As already mentioned this type of movement is outside the country control of the individual and can acquire different forms: twisting, slow, dance-like irregular, and unpredictable. Sometimes people suffering from dyskinesia learn sensory tricks to diminish their movements including, touching their face or chin with a finger or tucking their hand under their chin. All of this is done spontaneously without the patient noticing the same. These sensory tricks would not be available within the enclosed space of an MRI machine.

Although the above is purely speculation, it is what makes research worthwhile and exciting. I always say that research never ends with a period but with a colon or semicolon. It is a pity that all of this was missing in the reported micro-movements article.

References

Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders–Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2008. MMWR Surveil Summ. 2012;61(3):1-19.

Christensen D, Van Naarden Braun K, Doernberg N, Maenner M, Durkin M, Arneson C, Benedict R, Wingate M, Fitzgerald R, Kirby RS, Yeargin-Allsopp M. Prevalence of Cerebral Palsy, Co-Occurring Autism Spectrum Disorders, and Motor Functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008 Developmental Medicine and Child Neurology. October 2013.

Torres EB, Denisova K. Motor noise is rich signal in autism research and pharmacological treatments. Nature Scientific Reports 6 (article #37422) 2016 (http://www.nature.com/articles/srep37422)