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Stereotyped Motor Behaviors Associated with Autism in High-risk Infants: A Pilot Videotape Analysis of a Sibling Sample

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Abstract

This study examined motor behaviors in a longitudinal cohort of infant siblings of children with autism. Stereotypic movements and postures occurring during standardized observational assessments at 12 and 18 months were coded from videotapes. Participants included eight infant siblings later diagnosed with autism spectrum disorder (ASD), a random sample of nine non-diagnosed siblings, and 15 controls. Videos were coded blind to diagnostic group. At 12 and 18 months the ASD group “arm waved” more frequently and at 18 months, one posture (“hands to ears”) was more frequently observed in the ASD and non-diagnosed group compared to the controls. Overall, the siblings subsequently diagnosed with ASD and the comparison groups had considerable overlap in their repertoires of stereotyped behaviors.

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Acknowledgments

This research was supported by grants from the National Alliance for Autism Research and the Canadian Institutes of Health Research. Dr. Zwaigenbaum is supported by a New Investigator fellowship from the Canadian Institutes of Health Research. We thank the families who have participated in this research for their ongoing support and dedication.

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Correspondence to Lonnie Zwaigenbaum.

Appendix

Appendix

Description of the Motor Mannerisms (seen in at least one child)

Motor Item

Description

Postures

 

Finger Flexion (P)

Fingers move from mild flexion and held in full flexion

Finger Extension (P)

Fingers fully extended usually with some degree of hand extension

Finger claw (P)

Fingers abducted (spread out) with some flexion at the proximal and distal interphalangeal joints

Hand extension (P)

Fingers mildly flexed with hand in full extension, usually with some elbow flexion

Hand Flexion (P)

Fingers mildly flexed with hand in full flexion

Forearm extension (P)

Forearm fully extended, often with some hand and finger extension

Forearm out (P)

Humerus in external rotation with elbows a few inches lateral to lower ribcage, , forearm in 45–90 degrees of flexion and pronated with forearm and hands pointing away from midline

Forearm out with supination (W)

Same as “forearm out” except forearm is in supination, with palms facing upward

Forearm flexion (P)

Humerus in external rotation with elbow a few inches lateral to lower ribcage, forearm in 90 degrees to full flexion and pronated

Forearm flexion tense (W)

Same as forearm flexion but position change to forearm flexion was abrupt and posture was held with apparent tension

Arm up (W)

Shoulder extension with elbows clearly above shoulder

Arm Tense with overflow (W)

Similar to Forearm out except position held with tension and dysrhythmic small amplitude movements

Hands to ears (P)

Arms out to side in abduction and external rotation, full forearm flexion, with hands close to the ears, elbows pointing outward to the right and left“with hand extension” describes additional posture of “hands to ears” with hand extension

Arch head and trunk (P)

In sitting position, extension of the head with some hyperextension of the trunk, most often associated with becoming upset

Head abduction (P)

Head tilted to left or right with one ear closer to the shoulder

Tongue Protrusion (W)

Tongue stuck out of the mouth for more than one second

Mouth Open (W)

Mouth held open for longer than a few seconds. Yawning was not coded here

Stereotypies

Finger flexion (T)

Fingers and thumb flexion altogether and then extension of fingers and thumb altogether, repeatedly, sometimes when scratching an object or the air- “alternate” codes for flexion of one finger, followed by another and then another in rapid succession, as opposed to at the same time, with a repeat of the cycle. The movement was similar to rapid drumming of fingers, or playing a scale on the piano, with a repeat in the cycle

Finger flexion object (T)

Finger flexion as above but while squeezing a noisy squeaky toy or a quiet soft toy

Finger rotate (T)

As if fingers are turning a large dial in the clockwise then counterclockwise directions, 2nd and 3rd fingers flexed at distal interphalangeal joints (DIPs) with mild extension at the proximal interphalangeal joints (PIPs), and 4th and 5th fingers flexed at DIP joints with mild flexion at PIP joints, followed by flexion of the 2nd and 3rd fingers and extension of 4th and 5th fingers at PIPs, with mild flexion in fingers at the DIPs

Finger Point repetitively (W)

Pointing repeatedly at a picture in a book or object, without looking to others for joint attention

Hand rotation (T)

Supination and pronation of hand alone- “with object” codes for the movement occurring when an object is held

Hand flexion extension (T)

Flexion and extension of hand at wrist, “With object” codes for the movement occurring while an object is held

Arms

Arm Shake (T – Arm wave)

With forearm in 0–90 degrees of flexion, and humerus in 45–90 degrees of extension and in 0–60 degrees of abduction; movement of humerus with extension and flexion repeatedly, often with an amplitude of a few inches

Arm flap (P)

With forearm in 0–90 degrees of flexion (at elbow) and some pronation,, and humerus in extension and greater than 60 degrees abduction (90 degrees abduction meaning the elbows are pointing to each side, 0 degrees meaning both elbows pointing straight ahead.); Movement of arm at humerus, with abduction and adduction, with an amplitude of a few inches, and no movement at the elbow joint - “with object” and “with a noisy object”

Arm wave (P)

With forearm usually in 60–120 degrees of flexion at elbow and some pronation of forearm, humerus in extension (about 30–60 degrees) and abduction (30–90 degrees); movement of arm at humerus with internal and external rotation, with the wrists and hands kept fairly stable- “With hand flexion and extension” denotes movement of hand flexion and extension with “arm wave”

Arm bang surface (T)

forearm in mild flexion, extension and flexion at the humerus with hand in contact with surface, similar movement to “arm shake” but with arm now banging a table or surface

Arm bang surface with object (T)

Same movement as arm bang surface but holding an object. Silent and noisy objects were not additionally specified

Arm sway (T)

Forearm with mild flexion at elbow, and mild extension of humerus; movement at shoulder, sideways with rubbing of hand on table

Arm push pull (T – elbow bend)

With forearm parallel to floor; movement at elbow of forearm flexion and extension with appearance of a push and pull of hand back and forth, on a surface (table), often holding an object

Arms clap (T)

With forearms in mild flexion, and humerus extension so that arms in front of child, adduction to contact and midline and abduction, repeatedly

Arm bang object together (T)

Similar to arm clap with objects in hand

Torso

Trunk Sit bounce (T)

Torso straight: up and down movement, mostly from hip extension,

Trunk Sit sway (T)

Slow side to side movement with torso straight

Trunk Sit wiggle (T)

Quick sideways movements of lateral flexion of spine in one direction then the other, (curved like a “C” and then like a reverse “C”)

Trunk Sit Arch Rock (T)

Position: back arched, followed by movement of trunk rocking back and forth

Trunk Sit rotate (P)

Torso straight, rotation of spine along its vertical axis in one direction and then the opposite

Trunk Sit flexion extension (T)

Arching and relaxing of back

Trunk Stand bounce (T)

In Standing position, then flexion and extension of knees resulting in up and down movement of body

Head

Head shake (T)

Rotation of head about vertical axis, scored only if not in context of communication

Head nod (T)

flexion and extension of head, scored only if not in context of communication

Tongue protrusion (T)

Tongue pushed out of the mouth and retracted back into the mouth repeatedly, without any object being touched by the tongue

Tongue swipe (T)

Tongue protruded and moved from side to side

  1. (T) = movement described by Thelen (1979)
  2. (P) = items defined or observed during the pre-pilot study
  3. (W) = item observed and defined within study

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Loh, A., Soman, T., Brian, J. et al. Stereotyped Motor Behaviors Associated with Autism in High-risk Infants: A Pilot Videotape Analysis of a Sibling Sample. J Autism Dev Disord 37, 25–36 (2007). https://doi.org/10.1007/s10803-006-0333-5

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  • DOI: https://doi.org/10.1007/s10803-006-0333-5

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