Early motor skills delays can predict later language problems

Vanessa H. Bal, PhD

There is a big connection between motor skills and language, according to a recent report, which adds to a growing body of evidence demonstrating that motor deficits can help predict speech delays.

The study, published in the Journal of Child Psychology and Psychiatry, found that children who were minimally verbal at age 3 years and had continued speech delays into young adulthood, most often experienced fine motor delays in childhood, as well.

Vanessa H. Bal, PhD, Karmazin and Lillard Chair in Adult Autism, associate professor at the Graduate School of Applied and Professional Psychology at Rutgers in New Brunswick, New Jersey, and lead author of the study, says the report should serve as a reminder that language development is complex process.

"We need more studies to understand if the link between extremely delayed fine motor skills and subsequent language development reflects associations with other motor deficits affecting speech, developmental cascades, or other factors that affect development of both skill areas," Bal says.

According to the report, up to 74% of preschool-aged children with autism are minimally verbal, and more research is needed to understand what factors impact long-term expressive development in these children and what treatments can best help.

This study examined expressive language predictors in language-delayed preschoolers. The study group included 86 children who were diagnosed with autism spectrum disorder and language delays at 3 years old. The participants selected used single words or less based on Autism Diagnostic Observation Schedule Testing, and communication trajectories were compared using mixed model trajectories at age 10.5 and 19 years.

The research team found that a delay in fine motor skills was a key predictor in later delays in language and expressive communication among children with autism, with delayed fine motor skills being the strongest predictor of language at 19 years. The study results highlight severe motor delays as a particularly silent marker for identifying language-delayed children with autism who are at risk for long-term language delays.

As far as suggestions for interventions or prevention techniques for clinicians, Bal says that is a question that has yet to be answered fully.

"We do not yet know whether the fine motor association has to do with broader motor issues that could be targeted directly or more complex processes," Bal says. "However, one thing that pediatricians can do is refer children who show language delays for comprehensive assessments and encourage families to pursue assessments that will provide a picture of their child's strengths and challenges in areas including-but not limited to-language."

Although deficits in language are important, Bal says there is a lot to consider outside of the spoken word.
"It is easy to be focused on language if a young child is not yet speaking, but this suggests we need assessments of other domains, with motor skills being important but not the only factor to consider," Bal says.

Bal says she hopes the report will help lead to more in-depth assessments for children with autism who experience delays in these areas.

"I hope that children will receive more comprehensive assessments to understand their individual profiles of strengths and challenges in order to inform treatment programming to leverage strengths, skills to address challenges, and impairments. I also hope that service providers that support young children will be really cautious in taking the 'wait and see' approach when parents report concerns and make referrals sooner," Bal says. "Often there are long waitlists, so if a child is referred there is likely still time for them to be monitored and observed before the assessment takes place; however, if we delay referrals we run the risk of really missing critical developmental periods and opportunities for intervention. These practices will hopefully improve patient outcomes."

Pediatricians should also note the importance of participating in research in this area in order to advance therapies, she says.

"Several hundred families contributed information to the American and Canadian studies, not once, but on multiple occasions during their children's lives," Bal says. "Longitudinal studies are really invaluable to helping understand development, and we are so grateful for families willing to take time out of their lives to participate in research. Without their engagement, we would not be able to do important studies like these."