Analysis of Unsupported Gait in Toddlers with Autism

Background: A number of studies have suggested the importance of motor development in autism. Motor development has been considered a possible biomarker of autism since it does not depend on either social or linguistic development.

Objectives: Based on the hypothesis that suggests movement as an early indicator of Autistic Disorders (AD), the purpose was to analyze the first unsupported gait at the age when child reach the walking autonomy. Using retrospective video analysis we investigated the first unsupported gait in toddlers with Autism. Our study aims to verify, through observational methods, the possibility of distinguishing toddlers with ASD from toddlers with typical development or with developmental delay by movement.

Methods: Fifty-five toddlers, belonging to three groups were recruited: toddlers with autism (AD, n=20, mean age 14.2mo, sd 1.4mo) and as comparison groups: typically developing toddlers (TD, n=20, mean age 12.9mo, sd 1.1mo) and toddlers with non-autistic developmental delays of mixed aetiology (DD, n=15, mean age 13.1mo, sd 0.8mo).The Walking Observation Scale (WOS) and the Eshkol-Wachman Movement Analysis (EWMN) were used to gather data on the first unsupported gait. The WOS includes 11 items that analyze gait through three axes: foot movements; arm movements; global movements while the EWMN analyses static and dynamical symmetry during gait.

Results: Data shows significant differences in gait patterns among the group of toddlers with autism as opposed to those with typical development or with developmental delay. ANOVA shows significant differences (p<.01) between AD group and the two control groups for the total scores of the WOS (the average score among all the 11 items of the WOS). Tukey HSD Post-Hoc indicates that AD group shows higher WOS scores than DD (M difference = 7.62, SE = 2.84, p≤.001) and TD (M difference = 14.32, SE = 2.23, p≤.001); differences were also found between DD and TD (M difference = 9.21, SE = 2.41, p≤.001). Significant differences (p<.01) were also found between AD group and the two control groups for the EWMN. Tukey HSD Post-Hoc indicates that AD toddlers show more asymmetry than DD (M difference = 27.05, SE = 3.34, p≤.001) and TD (M difference = 25.75, SE = 3.09, p≤.001); no differences was found between DD and TD (M difference = 1.75, SE = 3.34, ns).

Conclusions: In this study we have identified significant differences in gait patterns among the group of toddlers with autism as opposed to the matching controls. The specificity of disturbances in motor sequence we have identified in autism (more postural asymmetry, more rigidity, also defined upper-body-type “Parkinsonian”) is consistent with previous findings that implicated cerebellar involvement in the motor symptoms of autism.