Exploring the Action–Perception Loop in Children Born Very Preterm: Associations Between Biological Motion Perception, Motor Coordination, and Behavioral Outcomes

PURPOSE: Children born very preterm (VPT < 32 weeks' gestation) are at elevated risk for neurodevelopmental difficulties, including social functioning, motor coordination, and perceptual processing, domains that also show overlap with autism-related profiles. Biological motion (BM) perception, which supports the extraction of social information from movement, may represent one important pathway through which early motor and perceptual functioning relate to later socio-emotional development. METHODS: We examined BM perception, motor coordination, and behavioral outcome in 64 VPT and 31 full-term (FT) (mean age = 12 years). BM perception was measured via eye-tracking, recording time to detect point-light walkers under low- and high-noise conditions. Motor skills were evaluated with the Movement Assessment Battery for Children-2nd Edition, and behavioral outcome with the Child Behavior Checklist. RESULTS: Children born VPT showed lower BM perception, poorer motor coordination, and more internalizing and social difficulties than FT peers. In the VPT group, poorer motor coordination was linked to reduced social competence and more internalizing symptoms, while lower BM perception was associated specifically with internalizing symptoms. Combined deficits were tied to the highest levels of anxiety and social withdrawal. BM perception was selectively related to gross motor skills, consistent with shared action-perception systems. No such associations appeared in the FT group. CONCLUSIONS: These findings highlight the interplay between perceptual and motor functioning and socio-emotional outcomes in children born VPT children. The observed associations point to potential developmental mechanisms that may increase vulnerability to social and emotional difficulties, offering insights relevant to autism and related neurodevelopmental conditions.