Commentary on “Early Developmental Trends in High-Risk Neonates Later Diagnosed With Autism Spectrum Disorder” : Pediatric Physical Therapy

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Commentary on “Early Developmental Trends in High-Risk Neonates Later Diagnosed With Autism Spectrum Disorder”

Ennis, Beth PT, EdD, PCS; Jensen-Willett, Sandra PT, PhD, PCS

Author Information
Pediatric Physical Therapy 35(1):p 35, January 2023. | DOI: 10.1097/PEP.0000000000000979
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“How could I apply this information?”

The number of children in the United States diagnosed with autism spectrum disorder (ASD) increased in the past 20 years from 1 in 150 in 2000 to 1 in 44 children in 2021.1 Although the disorder can be reliably diagnosed as early as 2 years or age, most children are not diagnosed until 4 years or age. This creates a substantial gap for children and families who need support. Motor skills offer an important opportunity for early interventionists, and specifically physical therapists, to screen for ASD if an association between early motor performance and later diagnosis can be established. Using the Test of Infant Motor Performance (TIMP), a well-validated early motor assessment, with a population of infants known to be at elevated risk2 may be a logical first step toward early detection. Yet, this study clearly establishes that testing of early motor performance does not detect differences in children who are later diagnosed with ASD. Specific items might have predictive value, rather than total scores. These findings support the importance of holistic developmental evaluation and the importance of advanced transdisciplinary training for providers who serve young, at-risk infants to understand how these domains interact and change across early development and in relationship to ASD.

“What should I be mindful of when applying this information?”

Medical management of prematurity is constantly advancing. Differences in medical care may create different risks and developmental outcomes. Longitudinal follow-up, across all developmental domains, is critical to understand these changing risks and outcomes. The authors discuss that standardized tests may not detect subtle indicators of ASD. Eye gaze and shifting, self-regulation, social interactions, and play skills should be considered. Physical therapists should continue to use assessment of motor skills, paired with screening of social, communication, and play skills, to detect signs of ASD early and refer to appropriate health care partners.

Beth Ennis, PT, EdD, PCS
University of St Augustine for Health Sciences
St Augustine, Florida
Sandra Jensen-Willett, PT, PhD, PCS
Munroe-Meyer Institute
University of Nebraska Medical Center
Omaha, Nebraska


1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Data & statistics on autism spectrum disorder. Accessed December 28, 2022.
2. Crump C, Sundquist J, Sundquist K. Preterm or early term birth and risk of autism. Pediatrics. 2021;148(3):e2020032300. doi:10.1542/peds.2020-032300.
© 2023 Academy of Pediatric Physical Therapy of the American Physical Therapy Association