The Association Between Motor and Social Skills in Young Autistic Children Enrolled in the Study to Explore Early Development

Motor difficulties are common in autistic individuals and may contribute to challenges in social development. Understanding the association between motor and social skills could inform interventions to improve developmental outcomes. Using data from the Study to Explore Early Development—a large, diverse sample of rigorously characterized preschool-aged autistic children in the United States—we aimed to (a) describe the frequency of motor challenges using multiple standardized instruments; and (b) evaluate associations between motor and social skills. Children were identified from health and education organizations and birth records. Caregivers completed standardized interviews and questionnaires, and children completed comprehensive developmental evaluations to determine autism status. Among 2,039 children meeting the study autism criteria, 67.3% exhibited motor scores ⩾2 standard deviations below the mean on at least one measure. Motor difficulties were more prevalent in the fine motor (up to 63.4%) than gross motor (14.2%) domain and among children with significant visual reception delays (up to 92.8%) than those without these delays (up to 32.0%). After adjusting for covariates, fine motor skills were significantly associated with social challenges in both functional and autism-specific domains. These findings highlight the importance of motor development in early autism evaluations. Lay abstract Many autistic children have challenges with movement skills, such as crawling, walking, or using their hands for tasks like drawing or eating. These motor difficulties can also affect how children learn, play, and interact with others. Understanding how motor and social skills are connected may help improve early support for autistic children. This study used data from the Study to Explore Early Development, a large research project that included preschool-aged autistic children from diverse communities across the United States. Parents completed interviews and surveys about their child’s development, and each child was evaluated by trained professionals to better understand their strengths and needs. We looked at over 2,000 autistic children and found that about 67% (two out of three) had motor skill scores that were well below what’s typical for their age. Motor difficulties were more common when children used small muscles in the hands and fingers, like when drawing or eating, than when they used large muscles, like when crawling or walking. We also found that children with stronger motor skills tended to have fewer social challenges. These results show that motor delays are not only common in young autistic children but may also be linked to how they develop social skills. Spotting motor difficulties early could help families and professionals better support each child’s development. Supporting motor skills in early childhood, along with communication and behavior, might help autistic children build stronger social connections. By raising awareness about the role of motor skills in autism, we could help make interventions more effective and equitable, leading to autistic children learning, playing, and connecting with others more easily.