Improving Hand Function in Adults with Autism Spectrum Disorder and an Intellectual Disability through Participation in an Adapted Physical Exercise Program

Background: As the prevalence of autism spectrum disorder (ASD) continues to rise, research specific to adults with ASD, as well as individuals diagnosed with both ASD and an intellectual disability (ID), remains limited. These individuals deserve recognition within the literature as they face distinct challenges, such as impairments in motor control. Recent research suggests that the motor impairments associated with ASD negatively affect participation in recreational and vocational activities and activities of daily living, beyond the impact of any accompanying cognitive impairment. Furthermore, when these motor deficits manifest themselves within the upper extremity (including the hand), they create difficulties in performing adaptive living skills, ultimately limiting independence and quality of life throughout adulthood. Therefore, it is important to develop strategies that mitigate such impairments in motor control, particularly within the hand, as fine motor control is essential to completing activities of daily living.  

Objectives: This study sought to examine the change in hand function among a group of adults with ASD-ID following participation in an adapted physical exercise (APEX) program focused on motor skill development.   

Methods: Eleven adults with ASD-ID (mean age = 35.5 years, age range = 20-61 years; 2 females) attended an APEX program for 90 minutes twice a week for twelve weeks. All participants engaged in whole body circuit training and practice on fine motor skills. A modified version of the Jebsen Test of Hand Function (JTHF) was administered prior to the program (pre-testing), following 12 training sessions (mid-testing), and following 24 training sessions (post-testing). A faster time to complete the subtests of the JTHF indicated a better performance. Subtest times were the sum of the times achieved for the right and left hand. Linear mixed modeling with compound symmetry repeated covariance structure and a fixed effect of trial (three levels: pre-, mid-, and post-testing) was employed to assess differences in hand function across the three testing periods for each subtest and the JTHF as a whole. Statistical significance was determined at p ≤ 0.05.

Results: A significant improvement between pre-testing and mid-testing was found for the checker stacking subtest of the JTHF (p = 0.009), as well as the total JTHF (p = 0.023). Additionally, a significant improvement between pre-testing and post-testing was found for three of the six JTHF subtests (card turning: p = 0.020; simulated feeding: p = 0.025; checker stacking = 0.024) as well as the total JTHF (p = 0.010). 

Conclusions: Overall, adult participants with ASD-ID improved their performance on half of the subtests of the JTHF that were administered, as well as performed significantly better on the JTHF as a whole after completing the APEX program. This suggests that adults with ASD-ID who participate in an APEX program focused on motor skill development can experience improvements in various aspects of hand function. The practical importance of these results is far reaching as an improvement in fine motor control may translate into a greater ability to perform adaptive living skills that are required for independence and quality of life among these individuals.