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Abnormal Movements in Autism: Association or Causality?

By Daniel J. Bonthius, MD, PhD | Winter 2023

Dr. Rujuta Wilson, an Assistant Professor of Child Psychiatry and Pediatric Neurology at UCLA, is exploring abnormal movements in Autism.

When people think of autism, they usually think only of deficits in language, social interactions, and behavior. However, motor impairments can also be present in autism. And these motor impairments may not only be associated with autism; they might also be causally linked to autism. Dr. Rujuta Wilson, an Assistant Professor of Child Psychiatry and Pediatric Neurology at UCLA, is exploring this novel concept.

The idea that abnormal movements may contribute to the development of autism stems from the recognition that exploration of the environment and the ability to socially engage with a caregiver depend upon a person’s ability to move properly. Deficits in movement may corrupt a child’s ability to explore, point, and convey thoughts, emotions, and reactions. Thus, movement abnormalities may undermine normal developmental processes and lead to precisely the types of deficits that constitute autism. Yet, there remain significant gaps in our understanding of what these motor impairments are and how they drive neurodevelopmental outcomes.

It is no accident that Dr. Rujuta Wilson’s research focuses on bodily movement. Movement has been of central importance to Dr. Wilson throughout her life. As a young child of Indian heritage, she was enthralled with dancing, learning ballet and traditional Indian dances. Continuing her interest in expressive movement, she minored in dance as an undergraduate at George Washington University, where she studied modern dance techniques. With a major in anthropology and a second minor in biology, Rujuta appreciated the interaction of culture, biology, and movement–an appreciation of interactions that paved the way for her eventual study of the role of movement in autism.

Dr. Wilson hypothesizes that impaired motor development in infancy can detrimentally impact a child’s exploration, social engagements, spatial perception, and visual coordination. She further hypothesizes that the negative cascading effect of these impairments has direct mechanistic links to the communication deficits, and repetitive and atypical motor behaviors observed in autism. To test these hypotheses, she examines a cohort of infants who are at high risk for autism (infants with an older sibling with autism).

Figure 1. Infant wearing sensors (placed in sleeves) on arms and legs to capture continuous quantitative whole-body movements.

The unique tool that Dr. Wilson uses to objectively study and quantify movements of children is the wearable movement sensor (Figure 1). These lightweight devices detect not only linear movement but also detailed aspects of infant movements, such as movement type, duration, and angular rotation. Worn on both wrists and ankles concurrently, the sensors are synchronized, thus allowing detection of movements that occur in coordination with each other. The sensors can also be deployed remotely to the home to capture movements in the child’s natural environment. Utilizing advanced signal processing and machine learning techniques, she and her team have created new measures that detect detailed characteristics of movement.

Figure 2. Wilson RB, et al. Slower pace in early walking onset is related to communication, motor skills, and adaptive function in autistic toddlers. Autism Research 2024; 17: 27-36.

Using these methods, Dr. Wilson and her coworkers have shown that high-risk infants with a later diagnosis of autism show lower variability in their movements compared to typically developing children. Furthermore, they found that the deficits in movement variability were more strongly correlated with autistic behaviors than with cognitive ability or adaptive skills (Reference 1). In addition, when quantitatively analyzing gait, Dr. Wilson’s team found that toddlers with autism acquire the ability to walk at a normal age but exhibit a pattern of slower pace, compared to typically developing children (Figure 2). They further found that the slower measures of pace were associated with lower scores of communication, motor skills, and adaptive function (Reference. 2).

Dr. Wilson believes that motor abnormalities may not just be a component of autism but may ultimately play a role in its diagnosis and treatment. Early motor differences could represent an endophenotype of autism. As such, detection of characteristic motor abnormalities may facilitate an earlier diagnosis of autism. Furthermore, if motor differences contribute to the language, social, and behavioral aspects of autism, then therapies for autism may need to be reconsidered and focus on remedies for the movement problems. Thus, Dr. Wilson’s ideas surrounding movement represent an important paradigm shift in the way that autism is considered and may have far-reaching consequences for the diagnosis and treatment of this important neurodevelopmental disorder.