Full length articleAge-related gait development in children with autism spectrum disorder
Introduction
Autism spectrum disorder (ASD) is characterized as a developmental disability that is associated with impaired social, communication, and behavioral skills according to the Centers for Disease Control and Prevention [1]. This condition is commonly diagnosed by either a physician or a psychologist using the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5; American Psychiatric Association, [2]). Despite numerous studies have found evidence of motor impairments in children with ASD and suggested that movement abnormalities may be an indicator of underlying neurological impairment; motor skill deficits are not considered to be core diagnostic symptoms in the DSM-5. Movement abnormalities have been identified in gait [[3], [4], [5]], balance [6,7], and during reaching tasks [8] for children with ASD when compared to children without ASD. It is important to understand how motor skills are affected by this condition since these abnormalities may impact a child’s activities of daily living and the development of social and communication skills.
Studies have investigated the walking patterns of children with ASD and atypical gait patterns have been reported [[3], [4], [5],[9], [10], [11]]. Compared to age-matched controls, children with ASD have demonstrated altered ankle and hip joint angles [3], increased step width [9], and reduced stride length [10]. However, some findings (e.g., spatiotemporal variables and joint range of motion) were not conclusive among studies [3,4,9,12]. The inconclusive findings could be due to different testing protocols and samples and could also be attributed to the heterogenous nature of ASD [11]. The heterogeneity of ASD walking patterns has been consistently observed in previous research [5,10,11], which may mask their unique individual characteristics when using group analyses. Matched-pair analyses have been proposed to provide a complete interpretation of the ASD heterogeneity [11]. To complement traditional gait analysis, a recent study utilized an innovative nonlinear analysis (i.e., continuous relative phase analysis) to assess inter-segmental coordination variability in children with ASD and observed reduced variability [13]. Children with ASD also demonstrated individualized side to side asymmetries [5]. This study identified significant ankle, knee, and hip joints asymmetries that were unique to each individual [5]. Asymmetry can be problematic since it causes an individual to compensate for one limb by using the other limb which could eventually lead to overuse injuries.
Gait development has also been shown to be impacted by age and walking speeds in healthy children [14,15]. Age has specifically been found to have a significant impact on sagittal plane gait mechanics for the ankle, knee, and hip joints in children between the ages of 7–12 [14]. Several studies have assessed gait in children with ASD, however, to our best knowledge, no research has been conducted to understand age-related gait development in children with ASD. A greater understanding of gait development and asymmetries in children with ASD may improve the development of treatment programs and thus, patient outcomes.
Therefore, the purpose of the present study was to investigate the age effect on gait in children with ASD. Specifically, we compared lower extremity joint kinematics and symmetry during walking in children with ASD among three different age groups: 6–8 years (under 8: U8), 9–11 years (U11), and 12–14 years (U14). We hypothesized that children with ASD would exhibit different joint kinematics among groups and improved symmetry in older age groups.
Section snippets
Participants
In the present study, 29 children (aged 6–14 years old) with mild ASD (level one) were recruited from a local autism summer camp. The inclusionary criteria were: (1) confirmed diagnosis of ASD by a physician or a psychologist using DSM-5 [2], (2) having the ability to understand instructions and communicate with the researchers, and (3) able to walk. The exclusionary criteria included any other chronic medical disorders, current medications, physical impairments and recent injuries that could
Results
The spatiotemporal gait kinematic variables are presented in Table 2. Comparisons of joint kinematics (Figs. 1 & 2 ) and gait symmetry among groups are presented in Table 3, Table 4, respectively. The main effect of group was significant for ankle dorsiflexion (F = 36.00, p = 0.00, partial η2 = 0.78) and knee flexion angle (F = 7.33, p = 0.00, partial η2 = 0.42) at heel-strike, and ankle dorsiflexion angle at toe-off (F = 7.20, p = 0.01, partial η2 = 0.38). The group effect was also significant
Discussion and implications
In the present study, we examined age-related gait development in children with ASD. Specifically, lower extremity joint kinematics and gait symmetry were compared among three different age groups: U8, U11, and U14. It was predicted that children would exhibit different joint kinematics among these age groups and improved symmetry in older age groups. However, these hypotheses were only partially supported by the results.
As expected, differences in joint kinematics were observed among the
Conclusions
In conclusion, some age-related kinematic changes in gait were observed in children with ASD. Older children exhibited less ankle dorsiflexion and knee flexion angles at heel-strike and greater plantarflexion angles at toe-off compared with younger children. In addition, decreased pelvis and thorax range of motion and increased shoulder range of motion were observed in older children. However, no development in gait symmetry was observed. The lack of group differences in gait symmetry could
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that there is no conflict of interest.
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