Motor Clumsiness

By: Tony Attwood and MAAP Services, Inc.

One of the first indicators of motor clumsiness is that some children with Asperger's Syndrome learn to walk a few months later than one would expect (Manjiviona and Prior 1995). In early childhood there may be a limited ability with ball games, difficulty in learning to tie shoelaces, and an odd gait when walking or running. When the child attends school, the teacher may be concerned about their poor handwriting and lack of aptitude in school sports. In adolescence a small minority develop facial tics, that is, involuntary spasm of muscles of the face, or rapid blinking and occasional grimaces. All these features indicate clumsiness and specific disturbances of movement.

Clumsiness is not unique to Asperger's Syndrome, and occurs in association with a range of disorders of development. However, research suggests that between 50 per cent and 90 per cent of children and adults with Asperger's Syndrome have problems with motor coordination (Ehlers and Gillberg 1993; Ghaziuddin et al. 1994; Gillberg 1989; Szatmari et al. 1990; Tantam 1991). Thus Corina and Christopher Gillberg have included motor clumsiness as one of their six diagnostic criteria. In contrast, the criteria of Peter Szatmari and colleagues and the American Psychiatric Association make no direct reference to motor coordination. However, the APA has a list of features associated with Asperger's Syndrome that includes the presence of motor clumsiness in the pre-school period and the delay of motor milestones. In addition, the field trials of their criteria have indicated that motor delays and clumsiness are very common in Asperger's Syndrome (Volkmar et al. 1994).

While there continues to be some confusion as to whether motor clumsiness should be a diagnostic criterion, there is no doubt that when it does occur with such children it can have a significant effect on their lives.

What abilities are affected?

There have been several studies that have investigated motor coordination in children with Asperger's Syndrome, using a range of standardized tests. These tests include the Griffiths, Bruninks-Oseretsky and the Test of Motor Impairment - Henderson Revision, The results suggest that poor motor coordination affects a wide range of abilities involving gross and fine motor skills. There have also been research studies of more specific motor skills and there is considerable information from clinical observation of movement. The author recommends that children with this syndrome have a comprehensive assessment by a physiotherapist and occupational therapist to determine the nature and degree of any problems with movement. The following are some of the areas where motor clumsiness is apparent, and some strategies to improve particular skills.

Locomotion

When the person walks or runs, the movements appear ungainly or "puppet" like, and some children walk without the associated arm swing (Gillberg 1989). In technical terms there may be a lack of upper and lower limb coordination (Hallett et al. 1993). This feature can be quite conspicuous and other children may tease the child, leading to a reluctance to participate in running sports and physical education at school. A physiotherapist or occupational therapist can devise a remedial program to ensure the movements are coordinated. This may involve the use of a large wall mirror, video recording, modeling and imitating more "fluid" movements using music and dance. It is interesting that the ability to swim appears least affected, and this activity can be encouraged to enable the child to experience genuine competence and admiration for proficiency with movement.

Basic skills

Catching and throwing accuracy appears to be particularly affected (Tantam 1991). When catching a ball with two hands, the arm movements are often poorly coordinated and affected by problems with timing, that is the hands close in the correct position, but a fraction of a second too late. One study noted the children would often not look in the direction of the target before throwing (Manjiviona and Prior 1995). Clinical observation also suggests the child has poor coordination in their ability to kick a ball. One of the consequences of not being good at ball games is the exclusion of the child from some of the most popular social games in the playground. They may avoid such activities because they know they lack competence, or are deliberately excluded because they are a liability to the team. Thus, they are less able to improve ball skills with practice. From an early age, parents need to provide tuition and practice in ball skills, not to be an exceptional sportsperson, but to ensure the child has basic competence to be included in the games. Some children can be enrolled in a junior soccer or basketball team to improve coordination and to learn how to play specific games. It is also important to have the child's eyesight examined to establish whether wearing glasses improves hand/eye coordination.

Balance

There can be a problem with balance, as tested by examining the ability to stand on one leg with eyes closed (Manjiviona and Prior 1995; Tantam 1991). Temple Grandin (1992) also describes how she is unable to balance when placing one foot in front of the other (tandem walking) i.e. the task of walking a straight line as though it were a tightrope. This may affect the child's ability to use some adventure playground equipment, and activities in the gymnasium. The child may need practice and encouragement with activities that require balancing.

Manual Dexterity

This area of movement skills involves the ability to use both hands, for example learning to dress, tie shoelaces or eat with utensils (Gillberg 1989). This may also extend to the coordination of feet and legs as in learning to ride a bicycle. Should the child have problems with manual dexterity, a useful strategy is "hands on hands" teaching - that is, a parent or teacher physically patterns the child's hands or limbs through the required movements, gradually fading out physical support. This characteristic of movement skills can continue to affect the manual dexterity of adults. Temple Grandin (1984) describes how:

I can perform one motor activity very well. When I operate hydraulic equipment such as a backhoe I can work one lever at a time perfectly. What I can not do is coordinate the movement of two or more levers at once. I compensate by operating the levers sequentially in rapid succession. (p. 165)

Handwriting

The teacher may spend considerable time interpreting and correcting the child's indecipherable scrawl. The child is also aware of the poor quality of their handwriting and may be reluctant to engage in activities that involve extensive writing. Unfortunately, for some children, high school teachers and prospective employers consider the neatness of handwriting a measure of intelligence and personality. The person with Asperger's Syndrome then becomes embarrassed or angry at their inability to write neatly and consistently. The child may well require assessment by an occupational therapist and remedial exercises, but modern technology can help minimize this problem. Children with Asperger's Syndrome are often very skilled at using computers and keyboards and the child could have special dispensation to type rather than write homework and examinations. The presentation of their work is then comparable to the other children. A parent or teacher aide could also act as the child's scribe to ensure the legibility of the child's written answers or homework. In tomorrow's world the ability to write longhand will become much less important, to the great relief of thousands of children with Aspe