Corinna Laurie, Clinical Lead Occupational Therapist at National Autistic Society, shares some strategies for developing motor skills.

Research and my clinical observations over the years have highlighted that many
autistic children often have difficulties with posture, coordination and motor planning.

Research consistently shows that autistic children can experience both gross and fine motor delays and/or atypical motor patterns (e.g. Green et al. 2002). A research study by Johnson-Ecker and Parham (2000) showed that autistic children achieved lower scores in praxis tests (the ability to conceptualise, plan and co-ordinate movements to carry out a motor task) than their typically developing peers.

Motor skill development depends on forming complex connections between different parts of the brain that link sensory information from the body with information from the environment, plus our innate motivation in order to plan and execute motor movements. There are many theories as to why these motor difficulties are so prevalent in the neurodivergent population, yet none are conclusive. Possible theories include:

• Differences in brain wiring - this may affect ideas and intentions, sensory integration, motor.
• Learning, prediction, body awareness, coordination and praxis.
• Joint hypermobility/low muscle tone - this affects core stability, postural stability, muscle strength and overall stamina.
• Anxiety - this can affect willingness to participate in challenging and novel tasks. It can lead to avoidance of activities and therefore a reduction in the development of motor skills.

Gross motor skills

Gross (large) motor movements involve balance, such as walking, running, riding a bike, throwing and catching. Activities to develop these skills include:

• Trampolining: This is an excellent piece of equipment which helps students develop muscle tone, balance and motor planning skills. Trampolines also provide proprioceptive input (an awareness of the body’s position and movement in space) which can be both regulating and calming.
• Swimming: Not only does this promote coordination skills but it also offers calming proprioceptive input.
• Playing on equipment: Give students plenty of opportunities to climb, run, slide and swing. 
• Playing Twister: This is a great game to help develop balance and body awareness.
• Playing with different types of balls: Encourage students to play games with a variety of different balls. Larger balls will be the best ones to start with. Scarves are also a good starting point as these move through the air slowly. 
• Playing animal games: Pretend to be different animals for example, squatting like a duck, jumping like a frog, standing on tiptoes like a giraffe.

Fine motor skills

Fine motor skills involve manipulation, such as grasping, threading and buttoning used daily tasks such as dressing, using cutlery, general tool use and writing or typing. Efficient fine motor skills are underpinned by many skills including:

• balance
• eye motor control (this is the ability for our eyes to work together in order to follow and/or hold an object in the line of vision as needed)
• hand–eye coordination
• manual dexterity
• hand and finger strength
• body awareness (proprioception)
• bilateral coordination − using two hands together with one hand leading (e.g. cutting with scissors while holding the piece of paper).

So, it’s not surprising that we all may struggle with the acquisition of precise and accurate fine motor skills.

Activities to develop these skills include: 

• Picking small items (e.g. buttons, beads) out of play dough with the thumb and index finger. Race against peers!
• Playing with dough –squeeze, flatten, cut and roll with scissors, cookie cutters or a garlic press.
• Lacing cut up drinking straws or macaroni onto string, spaghetti, or pipe cleaners.
• Screwing/unscrewing nuts and bolts, using construction kits.
• Looping a rubber band around a pencil several times. 
• Playing travel-sized games, such as Connect 4. 
• Using chopsticks to eat popcorn, raisins, peas, etc.

Handwriting is a complex skill that uses both fine and gross motor difficulties, along with visual perceptual difficulties. If a student has difficulties with motor coordination, then very often handwriting is never going to be a true representation of their cognitive ability and will definitely not be a fun activity!

Core stability 

Reduced core stability will impact on all motor skills including sitting posture, balance and stamina. Activities to improve core stability include:

• yoga
• Pilates
• using a gym ball and outdoor gym equipment. 

Try alternative seating such as wedge-shaped cushions and ensure student has feet rested on floor or block to aid stability. To assist fatigue, ensure seated sessions are alternated with brain breaks to maintain alertness levels.

Tips for everyday activities

Dressing:

• Sew sleeve buttons on with elastic so the arm can be pushed through.
• Use coloured stickers to match buttons with corresponding holes.
• Use socks with coloured heels and toes.
• Choose a coat with a contrasting lining to help differentiate inside and outside.
• Add a key ring or tab to zips to help with pulling up.

Using cutlery:

• Consider using shaped cutlery which guides the fingers into the correct position
• Consider plates with a high edge or use a plate guard to keep food on the plate.
• Place a sticker on the index fingernail and one on the cutlery where the finger should be placed as a visual guide.

Strategies to minimise sensory sensitivities also need to be considered – for example, alternative seating to aid balance or provide movement, or using spongy pen grips to make the pen ‘feel’ better.

Repetition is the key to developing motor skills, and interventions should be regular and short in length to maintain engagement in the activity. Although it may be challenging, given the right opportunities, patience and strategies everyone can improve their motor skills.

For more motor skill strategies along with sensory strategies and self-regulation tools please see my recent publication ‘Sensory and Motor Strategies (3rd Edition)’.