LAUSR

I thank Bishop et al. for the opportunity to have an open and cordial debate on the issue of including motor problems within the ASD definition in a future Diagnostic & Statistical Manual (DSM) revision. I encourage content experts and various stakeholders to weigh in on this issue as well. I will begin with the point that Bishop et al. was in agreement with, “recommending screening and assessment of motor problems in children with ASD.” About ~80% of children with ASD in the SPARK study received speech and occupational therapy (OT) interventions that mainly address their communication and fine motor/sensory processing problems (Bhat, 2020). Motor problems of children with ASD remain underdiagnosed (only ~15% have a co-occurring diagnosis of motor delay) and most likely gross motor issues remain undertreated (~13%–32% received recreational or physical therapy [PT] interventions, respectively) even when ~87% of the SPARK cohort was at-risk for motor impairment based on the Developmental Coordination Disorder Questionnaire (DCD-Q) (Bhat, 2020). ASD diagnosticians need a clear directive to screen for motor problems and must make referrals for assessment and treatment of fine and gross motor issues to movement clinicians (OTs and PTs), when appropriate. Adding motor to the definition of ASD will bring this issue on the radar of diagnosticians and stakeholders to better address these problems. Interventions for children with ASD must shift from sedentary play at the desk or on the floor to include everyday functional motor skills, complex movements, fine and gross motor play, and physical activity in small-to-large groups utilizing engaging creative and general movement contexts. Overall, I agree with and extend Bishop et al.’s statement that we need to improve motor screening and referrals to movement clinicians for further motor assessments and interventions of individuals with ASD throughout the lifespan. Next, I will address the points of disagreement one by one.