Motor Disorders in Autism: From Comorbidity to Core Criterion

While repetitive movements are recognized as a diagnostic hallmark of Autism Spectrum Disorder (ASD) in frameworks such as the DSM and ICD, other motor disturbances, including gait atypicalities and postural control difficulties, have historically been overlooked or framed as secondary comorbidities. This discrepancy persists despite growing evidence that motor signs in ASD are fundamental rather than incidental. Some of these motor and gait signs may be discernable early and could potentially forecast subsequent communication outcomes in certain cohorts. The current focus on observable behaviors in diagnostic systems may thus benefit from integration of motor dimensions, which could enhance early identification and support tailored interventions. Available experimental and clinical findings converge to indicate that motor dysfunctions in ASD are neither epiphenomena nor peripheral. They map onto cerebellar and basal ganglia dysfunction, impaired multisensory integration, and disrupted emotion-motor coupling that may impact cognitive and social outcomes. Future directions must go beyond the current phenotypical characterization of ASD. Motor screening could be integrated into early pediatric surveillance, and interdisciplinary motor-based interventions embedded into individualized care. More factually, we contend that motor and gait signs, beyond restricted and repetitive movements, should be incorporated into future revisions of DSM and ICD as diagnostic criteria for ASD. This would not only improve sensitivity to early and mild ASD phenotypes but also realign autism diagnosis with its neurological foundation. Recognizing motor specificities as an integrated part of ASD demands a paradigm shift: pediatricians and psychiatrists must embrace an embodied, motor-informed model of autism, bridging it with neurology to transform both diagnosis and care.