Autism and Movement Differences

Back in 1996, Martha Leary and David Hill began doing research on the types of challenges that autistic individuals have in regards to communication, challenging behaviors, and in the inability to control one’s movements. They called these challenges movement differences.  Their definition:

Movement difference is a difference, interference, or shift in efficient and effective use of movement. A disruption in the organization and regulation of perception, action, posture, language, speech and emotions.

So – movement differences may affect speech, thoughts, perceptions, memories, and emotions. They profoundly affect early experiences. They may impair learning about oneself, learning about textures, tastes, temperatures; learning about size, learning about orientation of the body in space, the development of perceptual skills and independence from others. 

In 2012, Martha Leary teamed with Anne Donnellan to write an excellent, in-depth book on this topic called Autism: Sensory-Movement Differences and Diversity. All seven chapters of this book has an extensive list of references for each of the topics covered as well as tables to visually organize the concepts covered. While this is a detailed read, it is accessible for parents, teachers, and other professionals.

Let’s delve into movement differences and how they present in autistic people, how we may label what we observe, and how we can support a person who has movement differences.

Symptoms of Movement Differences in Autism

Leary and Hill’s research found that autistic individuals’ movement differences or qualities are similar to other diagnoses such as Parkinson’s Disease, Tourette Syndrome, and Catatonia; however, when these symptoms are observed within the context of autism, the label is often a different one. For example, a person with Tourette Syndrome who can’t stop an action is understood as having a tic which is neurologically based; for an autistic person facing a social interpretation and not a neurological one, this may be labelled as challenging behavior or an unwillingness to stop and comply.

Here are some of the symptoms of movement differences in autism (Leary and Hill, 1996):

Apraxia/dyspraxia – difficulties in motor planning and sequencing of movements

Gait and posture abnormalities – odd body postures, freezing/catatonic postures, odd hand postures, slow or shuffling when walking, walking on tiptoes or jumping

Akinesia or dyskensia (seen in Parkinson’s) – difficulties initiating or switching movements, freezing or stopping movements

Tourette Syndrome symptoms – stereotyped movements, vocal, verbal, and physical tics, obsessive compulsive traits

Catatonia or catatonia like symptoms – mutism, echolalia, repetitive movements, automatic obedience, appearance of a lack or motivation, frenzy, excitement or agitation

Speech – aprosodic (abnormal rate, volume, intonation of speech), unintelligible speech, mumbling, poor articulation, nonsocial speech

Overall Behavior – overactivity which can look like excitement or aggressive behavior, underactivity which can look like indifference to physical contact, no imitation or impaired imitation, following routines in a repetitive way, aversion to physical contact

How We Might Label These Observed Symptoms

When these symptoms occur in autism and not in the other movement disorders mentioned, they often take on a different interpretation which is socially, not neurologically, based.

Some examples are:

People with Movement Disorders                                              Autistic People

Akinesia                                                                                                     Noncompliance

Festination                                                                                                Unneeded/excessive behavior

Bradykinesia (slowness of movement)                                          Intellectual disability

Tics                                                                                                                Abnormal behavior

Obsessions                                                                                                 Autistic behavior

What difficulties do movement differences cause?

Here are difficulties that movement differences cause for an autistic individual.

Starting or Initiating

Think about all the situations at home, work or school where you have to start or initiate something: putting pen to paper, eating a meal, changing clothes, moving from one room to another – the list is long. Thinking and speaking may be challenging if a person freezes. Starting a conversation then ending it may be impossible. Having to retrieve information on how to do something may take extra time. Accessing memory for people’s names, places, instructions, the daily timetable, where to go, or when to do something can be difficult.

Stopping

Sometimes when we start something, it can be hard to stop it. Some examples of not being able to stop are singing or talking out loud, asking the same questions over and over, touching or rearranging objects, perseverative thoughts, or shutting out sensory input. Not being able to stop may be related to the central nervous system’s inability to regulate body responses.

Executing

Executing is about rhythm, timing, speed, and accuracy. Many activities that we do encompass these four things such as driving, riding a bike, playing a sport, eating with utensils, or working on a computer. If rhythm, timing, speed, and accuracy are not working together evenly, actions can be altered enough to make you notice a difference in how the task is being performed.

Continuing

This is about flow either in thinking or movement. To have a conversation, your thought process has continual movement. Continuing any task such a reading a book, following a recipe, staying on task, or finishing a meal when there are movement differences can be challenging.

Combining

There are many activities that involve combining functions such as watching and listening, looking and doing, and listening and speaking. Our sensory system is constantly receiving input which we are regulating. Combing is difficult if an autistic person struggles with regulation of sensory input. Think about sitting in a classroom – there are students talking, a teacher at the front, bright lights, students moving about, noise from the hallway, busy bulletin boards, someone drinking water from a straw. It’s overwhelming to have to sort all of that input.

Transitions – Switching

Transitioning from one activity to another is a part of life at home, work, school and in the community. Transitions involve stopping one activity and starting another or moving from one location to another one to begin something new. Studies have shown that up to 25% of the school day may be spent in transition activities such as changing classrooms, going outside for recess, lunchtime, putting items in lockers, or getting materials for a task. There are similarities in the workplace and at home such as moving from one task to another, attending meetings or social events, eating meals and leisure breaks.

Transitions can also happen internally – a shift in thinking, action, perception, or from one emotional state to another.

Switching may require a great deal of effort and concentration for autistic individuals.

How can we support an autistic person who has movement differences?

Much of what was described in the last section relates to autistic inertia. Some ideas to provide support are:

1. Provide structure. I’ve written numerous posts on how to create structured environments and using visual supports.
2. Teach the concept of time and time management.
3. Organize the day around a person’s energy levels. Some people are early risers, others are night owls.
4. Create To-Do lists and have visual reminders. Visual reminders can be sticky notes, colored cards, or checklists.
5. Do work tasks in a distraction free area.
6. Establish routines. Set times for getting up, going to bed, mealtimes, bathing, and exercising.
7. Do one thing at a time. Multitasking can be overwhelming.
8. Provide prompts. We all need prompts until a sequence of actions become automatic, This can be done verbally, through touch, or providing help with starting off a task.
9. Break tasks down into manageable steps. 
10. Create predictability. When a person knows the expectations and how the task will unfold, this will ease anxiety.

All communication requires movement. Even emotions, thoughts and memories may require “movement” on a smaller neurological level.  We have to understand that autistic individuals perceive the world differently. Every person will need  accommodations such as contrived strategies, gestures, touch, rhythm, visualizations, music, and perhaps a specific support person. Accommodations will be different for every person and can change with time and situations.

The most important thing to remember is autism is the way people are rather than a thing people have. We can’t change who a person is but we can develop a deeper understanding of things such as movement differences, and adapt and support accordingly.

Additional Reading/Resources

Sensory Processing is Only Half the Story: Movement Differences in Autistic People – By Michelle Sara (first person experience)
Autistic People Move Differently, Too – By Sara Kurchak (first person experience)
Clinical Implications of Sensory-Movement Differences in Autism – YouTube Webinar Lecture

References

Davis, K. Movement Difference: A Closer Look at the Possibilities. Indiana Resource Center for Autism.
Leary, M. R., & Donnellan, A. M. (2012). Autism: Sensory-movement differences and diversity. Cambridge Book Review Press.