The association of motor coordination impairment and social communication deficits in children with autism is mediated by executive function

doi:10.21203/rs.3.rs-3326680/v1

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The association of motor coordination impairment and social communication deficits in children with autism is mediated by executive function

https://doi.org/10.21203/rs.3.rs-3326680/v1

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Background: Motor coordination impairment could contribute to social communication deficits in children with autism (ASD). However, the exploration of the mechanism implicated in these claims has been limited by the lack of potential confounders such as executive function (EF).

Methods: We investigated the role that EF plays in the relationship between motor coordination and social communication in a school-aged autistic population via a structural model in a statistically robust manner. The results of questionnaires, including the Developmental Coordination Disorder questionnaire, the Behavior Rating Inventory of Executive Function, and the Social Responsiveness Scale, were collected to measure motor coordination, social communication deficits, and EF.

Results: A total of 182 ASD children (7.61±1.31 years, 87.9% boys) were included in the final analysis. In the model with EF as a mediator, the total effect (β=-0.599, P<0.001) and the direct effect (β=-0.331, P =0.003) of motor coordination function on social communication were both significant among ASD children without intellectual disability (ID), as were indirect effects through EF (β=-0.268, P<0.001).

Conclusion: EF partially mediates the motor coordination and social communication correlation among ASD. We suggest that motor coordination should be included in the routine evaluation of autism surveillance and rehabilitation procedures.

autism spectrum disorders

motor coordination

social communication deficits

executive function

mediating effect

Autism Spectrum Disorder (ASD) is an increasingly prevalent neurodevelopmental disorder with 1 in 44 children diagnosed with ASD(1). As one of the core symptoms of ASD, social communication deficit is challenging for ASD children in daily life and negatively impacts their prognosis (2, 3). Additionally, it is reported that 86.9% of children with ASD are at risk for motor coordination difficulties (4), and correlational studies supported the positive relationship between motor coordination function and social communication in this population (5, 6). Recent evidence also suggested that motor-related interventions improve social communication in individuals with ASD (7, 8), highlighting the potential importance of motor coordination function in understanding the etiology of ASD.

Although a review of the literature showed a close relationship between motor coordination function and the social communication of ASD (see Table 1), the nature of the association remains unclear. Taverna et al. proposed a bidirectional model: children with ASD who have better motor coordination function respond more positively to interventions and benefit more in terms of alleviating core symptoms, including social communication. Inversely, improvement in social communication may lead children to engage more in physical activities, thus consequently displaying significant improvement in the motor domain (9). This model is partially supported by several studies of motor-related intervention among individuals with ASD (7). Therefore, to better understand the mechanism underlying the social communication deficit of ASD and to support early intervention practices for educators, it is urgent to explore the relationship between motor coordination and social communication and the potential mediators.

Table 1

Demographic characteristics of the participants grouped by gender. (n = 182)
Characteristics		ASD-ID (N = 45)	ASD-only (N = 137)	T value/ χ² value	P value
Age (mean ± SD)		7.68 ± 1.38	7.59 ± 1.29	0.379	0.705
Gender	Boys	84.4%	89.1%	0.676	0.411
	Girls	15.6%	10.9%
Right-handed	Yes	75.9%	78.3%	0.077	0.781
	No	24.1%	21.7%
Only-child	Yes	60.0%	46.0%	2.662	0.103
	No	40.0%	54.0%
Maternal age (mean ± SD)		36.13 ± 4.49	37.29 ± 3.48	-1.797	0.074
If the mother has a bachelor degree or above	Yes	77.8%	81.8%	0.344	0.557
	No	22.2%	18.2%
Per capita family income	< 8000 Yuan	73.3%	49.6%	7.703	0.006*
	≥ 8000 Yuan	26.7%	50.4%
Intervention history	Yes	57.1%	68.5%	1.516	0.218
	No	42.9%	31..5%
DCDQ (mean ± SD)
Fine motor/handwriting		9.71 ± 4.01	11.77 ± 3.56	-3.254	0.001*
General coordination		23.96 ± 5.24	23.28 ± 5.71	0.705	0.482
Controlling during movement		18.84 ± 5.13	18.28 ± 5.18	0.630	0.529
EF (mean ± SD)		67.07 ± 8.94	61.98 ± 9.35	4.808	< 0.001*
SRS (mean ± SD)
Social awareness		11.58 ± 2.90	10.79 ± 2.55	1.740	0.084
Social cognition		20.44 ± 4.06	15.90 ± 5.24	5.315	< 0.001*
Social communication		33.16 ± 7.63	26.22 ± 8.86	4.709	< 0.001*
Social motivation		14.82 ± 4.17	12.04 ± 5.11	3.308	0.001*
Autistic mannerisms		17.09 ± 5.45	13.19 ± 5.88	3.928	< 0.001*
*p < 0.05; SD, standard deviation; ASD, autism spectrum disorder; IQ, Intelligence Quotient; DCDQ, The Developmental Coordination Disorder Questionnaire; EF, executive function; SRS, The Social Responsiveness Scale.

ASD children with motor coordination difficulties usually exhibit poor performance in gross and fine motor, coordination, postural control, standing balance, etc. (10); these essential motor skills are usually conducted in a sequence of movements that involves aspects of executive function (EF) (11). EF is a set of higher-order cognitive processes that regulate, monitor and control cognition, emotions, and behavior. Evidence also suggests that difficulties with EF are associated with motor coordination difficulties (12), and the improvement of EF could benefit from motor-related interventions (13). Meanwhile, better EF could also predict superior social communication functions among ASD children (14–16), possibly because EF improves social communication by promoting higher-order processes, such as emotional and cognitive regulation (17). Additionally, EF-related intervention also supports this association (18). Thus, EF may act as a potential mediator in the relationship between motor coordination difficulties and social communication deficits.

In Table 1, we listed the previous studies covering motor coordination, EF, and social communication in ASD. Most studies have only explored the link between motor coordination and social communication; however, the results remain inconclusive. Two studies identified no significant differences in the relationship (19, 20). A limited sample size (21–27), a wide age range among participants (5, 19, 20, 28–33), and the use of various measurement tools for assessing motor coordination and social communication (20, 34, 35) may compromise the generalizability of the current findings. In terms of EF, most studies have considered the association between motor coordination function and EF or between EF and social communication separately. Only one intervention research concerning EF is available, which implied that motor-related intervention could enhance both social communication and EF (36). Moreover, it is worth noting that the indirect effect of EF difficulties on the relationship between motor coordination difficulties and internalizing symptoms was once discussed (37), highlighting the necessity to explore the potential effect of EF on motor difficulties and social communication among ASD. Furthermore, there is evidence that autistic children with intellectual disability (ID) are distinctly different from those with normal cognition in respect of both motor coordination and social communication (31). Thus, it is necessary to take cognitive levels into consideration when determining their potential impact on this relationship.

This research aimed to gain an understanding of the association between motor coordination difficulties, EF, and social communication deficit among ASD children aged 6–12 years and explore the potential role of EF in the motor coordination–social communication correlation. We hypothesize that 1) social communication deficits could be positively predicted by motor coordination difficulties among ASD children, and 2) EF, as the mediator in this relationship, may be affected by motor coordination difficulties and further impairs social communication. A total of 118 ASD children were recruited, and motor coordination function, EF, and social communication were evaluated by validated parent-reported questionnaires or observational scales. Structural equation modeling (SEM) was used to test the hypothesis. To the best of our knowledge, this is the first study to explore the potential role of EF in the relationship between motor coordination difficulties and social communication. Additionally, we relied on child psychologists/psychiatrists to diagnose child autism, and autistic children with and without ID were analyzed separately.

Participants and data collection procedure

The baseline data of children with ASD from an ongoing study in China were used. All the samples in this study were recruited from March 10, 2019, to September 7, 2022. The children had been diagnosed with ASD by hospitals at the beginning of the recruitment period, and the diagnosis was confirmed by a child psychiatrist on the research team using the Diagnostic and Statistical Manual of Mental Disorders, Fifth-Revision (DSM-5) criteria, and the Childhood Autism Rating Scale (CARS), to obtain a reliable autism sample. The additional inclusion criteria included (1) aged from 6 years 0 months to 12 years 11 months; (2) the voluntary participation of the children’s parents; (3) no other neurodevelopmental disorders; and (4) no severe sensory, perceptual disorders or physical handicaps. To ensure the independence of the observations, if a family had two or more eligible children, only the first-born child was recruited. A total of 182 children with ASD were enrolled and comprised those who were able to complete all the assessments. Parent-reported questionnaires were used to obtain demographic information, motor coordination function, EF, and social function. A licensed researcher conducted a behavior evaluation of the child, which included the useof the Childhood Autism Rating Scale (CARS) and the Wechsler Intelligence Scale for Children (Fourth version, WISC-IV, Chinese version). This study was approved by the Ethics Committee of the author's institution, and signed written informed consent was obtained before the questionnaire was completed.

Motor coordination assessment

The Developmental Coordination Disorder Questionnaire (DCDQ, Chinese version) (38, 39) was used to measure motor coordination. The DCDQ is a 17-item parent-reported questionnaire consisting of three domains of motor coordination which were fine motor/handwriting, general coordination, and control during movement. The total score ranges from 17 to 85, with higher scores associated with better motor coordination, as well as its subscales. The Cronbach’s alpha value of the total DCDQ score in this study was 0.700.

Executive function assessment

The Behavior Rating Inventory of Executive Function (BRIEF, Chinese version) (40) was used to assess the EF of children with ASD. The BRIEF is an 86-item parent-reported scale that can be organized into two composite indices: the behavioral regulation index (BRI) and metacognitive index (MCI). The BRI was derived from the inhibit, shift/flexibility, and emotional control subscale, and the MCI was derived from the initiate, working memory, plan/organize, organization of materials, and monitor subscales. Then, a standardized total score was generated from both of the indices to account for the EF of children, with higher scores related to increased EF difficulties.

Social communication function assessment

The Social Responsiveness Scale (SRS, Chinese version) (41) was used to evaluate the children’s social communication deficits. The SRS is a 65-item parent-reported questionnaire consisting of five domains (i.e., social awareness, social cognition, social communication, social motivation, and autistic mannerisms). For each question, the parents were asked to describe their child’s behavior over the last six months. The total possible scores range from 0 to 195, with higher scores indicating increased social impairment. The Cronbach’s alpha value of the total SRS score in this study was 0.879.

Covariates and cognition assessment

Based on a review of the literature, (42, 43), the following potential covariates were included: age, gender, if the participant is an only child in the family, handedness, caregiver of the child, maternal age, maternal education level, household income, and intervention history. The Wechsler Intelligence Scale for Children (Fourth version, WISC-IV, Chinese version) (44) was used to identify the global intellectual functioning as full-scale IQ (FSIQ). According to the DSM-5, children with an FSIQ < 70 were classified into the ASD-ID group and others were classified into the ASD-only group.

Statistical analysis

Data analyses were conducted during March and April 2023. The statistical analyses were performed using the Statistical Program for Social Sciences (SPSS) version 25.0 and Mplus version 8 (Los Angeles, CA) software packages. Continuous variables and categorical variables are presented as either mean (SD) values or percentages, respectively.

The intercorrelations of DCDQ, EF, and SRS were explored using Pearson correlations. To test the relationships between DCDQ, EF, and SRS, the structural equation modeling technique (SEM) was employed using the maximum likelihood robust (MLR) method in Mplus. MLR is a method widely used to ensure better performance when using nonnormal data, especially in studies with a small sample size (N < 400) (45). In SEM, the proposed hypothesized model is evaluated for the goodness of fit with actual observations from the sample data. We used the following fit indices to evaluate the model/data fit: Chi-square, Chi-square/df, root mean square error of approximation (RMSEA), comparative fit index (CFI), and standardized root mean squared residual (SRMR). A Chi-square/df below 3, an RMSEA below 0.08 (46), CFI estimates greater than 0.9, and an SRMR below 0.08 are indicative of reasonable model-data fit (47). A combination of the full set of indices was used to evaluate the model fit. Then, using the MLR estimation procedure, we tested the mediating effects of EF on the relationship between DCDQ and SRS in the ASD-ID group and ASD-only group, respectively. A two-tailed p-value < 0.05 indicated statistical significance.

Demographic data

All the participant characteristics are summarized in sTable 2. Among the 182 children with ASD (7.61 ± 1.31 years) included in the final analysis, 87.9% were boys, 49.5% were the only child in the family, 77.8% were right-handed, 80.8% had a maternal education of a bachelor's degree or above, 44.5% had a family per capita income over CNY 8000, 65.8% had an ASD intervention history, and 24.7% had an IQ below 70. The mean maternal age was 37.01 ± 3.78 years.

Compared with the ASD-ID group, more participants in the ASD-only group had a higher family income (50.4% vs. 26.7%, p = 0.006). The ASD-ID group also received higher scores in EF (67.07 ± 8.94 vs. 61.98 ± 9.35, p < 0.001), social cognition (20.44 ± 4.06 vs. 15.90 ± 5.24, p < 0.001), social communication (33.16 ± 7.63 vs. 26.22 ± 8.86, p < 0.001), social motivation (14.82 ± 4.17 vs. 12.04 ± 5.11, p = 0.001), and autistic mannerisms (17.09 ± 5.45 vs. 13.19 ± 5.88, p < 0.001), and had poor performance in fine motor/handwriting (9.71 ± 4.01 vs. 11.77 ± 3.56, p = 0.001).

Correlation analyses

Given that the SRS factors and EF scores differed between the cognitive groups (Table 1), we explored the intercorrelations of the manifest variables in each group using Spearman's correlation analysis. The means, SD, and correlations of the manifest variables are presented in Tables 2 and 3. In the ASD-only group, the correlations between the DCDQ, EF, and SRS were significant. The subscales of DCDQ were all negatively correlated with EF and SRS (P all < 0.05), except for the correlation of fine motor/handwriting and social awareness (p = 0.074) and social motivation (p = 0.141), and EF was positively correlated with all of the SRS subscales (P all < 0.05). However, in the ASD-ID group, only the score of general coordination was correlated with EF (p = 0.021), as was social motivation (p = 0.036).

Table 2

Intercorrelations of DCDQ, EF and SRS among ASD-ID group(N = 45).
Variables	mean	SD	1	2	3	4	5	6	7	8
DCDQ
Fine motor/handwriting	9.71	4.01	1
General coordination	23.96	5.24	0.352*	1
Controlling during movement	18.84	5.13	0.432**	0.556**	1
EF	67.07	8.94	-0.269	-0.351*	-0.183	1
SRS
Social awareness	11.58	2.90	-0.201	-0.095	-0.126	0.480**	1
Social cognition	20.44	4.06	0.039	-0.266	-0.043	0.515**	0.453**	1
Social communication	33.16	7.63	0.051	-0.148	-0.015	0.493**	0.613**	0.795**	1
Social motivation	14.82	4.17	-0.075	-0.321*	-0.183	0.361*	0.486**	0.600**	0.715**	1
Autistic mannerisms	17.09	5.45	0.111	-0.143	0.018	0.401**	0.454**	0.597**	0.796**	0.620**
Note: age, gender, and IQ were adjusted; *Correlation is significant at the 0.01 level (2-tailed); Correlation is significant at the 0.05 level (2-tailed); DCDQ, The Developmental Coordination Disorder Questionnaire; EF, executive function; SRS, The Social Responsiveness Scale.

Table 3

Intercorrelations of DCDQ, EF and SRS among ASD-only group(N = 137).
Variables	mean	SD	1	2	3	4	5	6	7	8
DCDQ
Fine motor/handwriting	11.77	3.56	1
General coordination	23.28	5.71	0.282**	1
Controlling during movement	18.28	5.18	0.438**	0.502**	1
EF	61.98	9.35	-0.369**	-0.425**	-0.258**	1
SRS
Social awareness	10.79	2.55	-0.154	-0.344**	-0.277**	0.508**	1
Social cognition	15.90	5.24	-0.229*	-0.320**	-0.333**	0.530**	0.520**	1
Social communication	26.22	8.86	-0.213*	-0.405**	-0.405**	0.629**	0.620**	0.766**	1
Social motivation	12.04	5.11	-0.127	-0.318**	-0.303**	0.433**	0.351**	0.525**	0.658**	1
Autistic mannerisms	13.19	5.88	-0.249**	-0.435**	-0.333*	0.630**	0.533**	0.660**	0.804**	0.556**
Note: age, and gender were adjusted; *Correlation is significant at the 0.01 level (2-tailed); Correlation is significant at the 0.05 level (2-tailed); DCDQ, The Developmental Coordination Disorder Questionnaire; EF, executive function; SRS, The Social Responsiveness Scale.

Structural Model

Structural model without mediators

In the first model, the direct effects of the predictor (DCDQ) on the dependent variable (SRS) were tested without a mediator using SEM. The direct standardized path coefficients were shown in Fig. 1. In the ASD-only group, the direct effect indicated that DCDQ was negatively significantly associated with SRS (β=-0.54, P < 0.001). The obtained indices showed that the model was acceptable: Chi-square = 32.784, Chi-square/df = 0.993, RMSEA = 0.062, CFI = 1.000, and SRMR = 0.061 (Fig. 1a). In the ASD-ID group, the model fit was acceptable (Chi-square = 59.050, Chi-square/df = 1.789, RMSEA = 0.132, CFI = 0.860, SRMR = 0.109), while the effect of motor coordination on social communication deficit was insignificant (p > 0.05) (Fig. 1b). Figure 1 also depicts the unique contributions of the individual subscales (dimensions) as indicators of the global factors of DCDQ and SRS.

Structural model with mediators

Given that there was no significant direct effect of motor coordination on RRBs in the ASD-ID group, we only explored the mediating effect of EF in the ASD-only group. In the mediation model, EF was included as the mediator (Fig. 2). A significant total effect of DCDQ on SRS emerged (β=-0.599, P < 0.001). When dividing the total effect into the direct effect of DCDQ and the indirect effect of EF, the direct effect of DCDQ was significant (β=-0.331, P < 0.001), as was the indirect effect of EF (β=-0.268, P < 0.001). This indirect effect indicated that although DCDQ had a significant correlation with SRS, EF partially mediated a negative relationship between DCDQ and SRS. The obtained indices showed that the model fit the data well (Chi-square = 60.325, Chi-square/df = 1.47, RMSEA = 0.059, CFI = 0.967, SRMR = 0.069). The direct standardized path coefficients are shown in Fig. 2. Additionally, the total effects, direct effects, and indirect effects in the mediated model with a 95% confidence interval were shown in Table 4.

Table 4

Direct, indirect and total effects for the partially mediated models of EF among ASD-only group.
Model pathways	Estimated effect	Product of Coefficients			95% CI
Model pathways	Estimated effect	S.E.	Est./S.E.	p-value	Lower bonds	Upper bonds
Total effect from DCDQ to SRS	-0.599	0.071	-8.440	＜0.001	-0.738	-0.460
Direct effect
DCDQ → SRS	-0.331	0.085	-3.894	＜0.001	-0.497	-0.164
Indirect effect
DCDQ → EF → SRS	-0.268	0.054	-4.989	＜0.001	-0.374	-0.163
Note: All factor loadings were standardized; age, and gender were covariates for each variable.

This study provides an understanding of the relationship between motor coordination difficulties, executive function, and social communication deficits among children with autism. Based on a structural equation model, we confirmed that motor coordination difficulties are positively associated with the severity of social communication deficits in ASD children without ID. Most importantly, when the mediating effect of EF is considered, we reveal that EF partially mediates the relationship between motor coordination difficulties and social communication deficits. To be specific, better motor coordination function may be associated with stronger EF, and the stronger EF may buffer against the social communication of autism.

In both models with and without the mediator, our findings confirmed the hypothesis that better motor coordination function is associated with less social communication deficit in children with ASD, which was partly consistent with previous cross-sectional studies (5, 6). According to the model proposed by Taverna (9), ASD children with better motor function may respond positively to intervention and benefit more from intervention in terms of enhanced social function. In turn, the alleviation of core deficits could lead children to engage more in physical activities and show improvements in motor function. However, in contrast with the findings of Ketcheson et al. (31), we identified no significant association between motor coordination and social communication within the ASD-ID group, which may be attributed to the limited sample size in our study. With a sample size of 10,234 children, Ketcheson et al. found that motor coordination difficulties are associated with social communication (via the Social Communication Questionnaire) and are independent of ID. Thus the relationship in the ASD-ID group should be confirmed in future research with an expanded sample size.

The mediating model revealed that EF partially mediated the relationship between motor coordination difficulties and social communication deficits. It has been highlighted that the development of EF is closely related to motor skills (48, 49), which provide important opportunities for interactions with the environment and other people and are crucial for learning about the world (50). This is also consistent with previous research suggesting that children with motor coordination difficulties had difficulties with inhibition control, working memory, and planning (51, 52). These impairments may be related to disturbances in visuospatial processing among children with motor coordination difficulties, leading them to pay more attention to visual information while performing the tests (53). Thus, our results showed that ASD children exhibit a similar trend. With better motor coordination function, children tend to engage more in physical activity, which provides learning experiences necessary for proper cognitive development, such as those related to paying attention, remembering instructions, and remembering the necessity to inhibit irrelevant actions (54) and further reinforces EF. Therefore, our results and the current literature both support this relationship between motor coordination function and EF.

In the meantime, social impairment can be predicted by EF deficits in ASD (14–17), which explains the mediating effect. EF may influence social communication function by facilitating higher-order strategies, such as emotional control, initiation, and monitoring. For emotional control, children with difficulties in emotional expressions and modulating or regulating emotional responses tend to experience social rejection and social isolation. Additionally, children with difficulties in initiation may find it hard to begin tasks independently or create new conversations with peers, and this consequently limits the development of their social communication (17). This is also supported by the intervention of EF, which revealed the function of EF intervention in enhancing social communication function (18). In addition, neuroimaging studies have revealed the closely linked neural basis of EF and social function in ASD children. Evidence suggests that social communication deficits are associated with altered function in the frontal and parietal networks (55, 56), which are responsible for the integration of cognitive processes and executive control (56, 57). These findings support our proposal and provide plausible evidence that EF may play a key role in the relationship between motor coordination difficulties and social communication deficits.

Our model of motor coordination difficulties, EF, and social communication deficits is supported by several types of such interventions. Research shows that motor-related interventions could achieve significant effects on the improvement of social communication in children with ASD (8, 36, 58–60), as well as their EF (36, 61–63). Motor-related intervention could promote the ability of action-planning and the inhibition of undesired behaviors among autistic children and provide opportunities for them to interact with peers and instructors; thus, the increased social stimulation may prompt social communication function (7). This indicates that motor-related intervention could improve the social communication of autistic children by increasing EF, which is in accordance with our results.

The results of this study have important implications in the field of autism diagnosis and management, as motor coordination function and early life motor delay strongly predict the diagnosis of ASD (64). Our findings add to the literature by providing a better understanding of the relationship between motor coordination difficulties, EF, and social communication deficits of autism and indicate the importance of motor coordination evaluation in the rehabilitation of ASD children. In addition, the potential intervention value of EF in the rehabilitation of autistic children should be considered.

The current research has several strengths. This study used a representative sample of children with ASD, including children with normal cognition and ID. ASD diagnosis was made by a child psychologist through the DSM-5 criteria, and standardized scales (i.e., DCDQ, SRS, and BRIEF) were used to assess the behavior of the children.

This study suffered from several limitations. First, the motor coordination difficulties, EF, and social communication deficits were collected from parent reports; thus, self-report bias could not be excluded. Therefore, objective performance-based measurements should be considered in future studies. Then, the cross-sectional nature of this study limited the causal claims of the relationship. Longitudinal studies with objective performance-based measurements are needed.

In this research, the relationship between motor coordination function and social communication deficits of ASD was confirmed. It indicates the importance of evaluating motor coordination in the diagnosis and management of autism, thus improving the prognosis of autism. In addition, it provides a potential mechanism explaining the association between motor coordination difficulties and social communication by having studied executive function. We conclude that executive function partially mediates the relationship between motor coordination difficulties and social communication deficits among autistic children, and both motor-related intervention and EF-related intervention should be promoted in autistic rehabilitation.

ASD, autism spectrum disorder

EF, executive function

ID, intellectual disability

DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

CARS, Childhood Autism Rating Scale

WISC-IV, the Wechsler Intelligence Scale, fourth Edition

DCDQ, Developmental Coordination Disorder Questionnaire

BRIEF, Behavior Rating Inventory of Executive Function

BRI, Behavioral Regulation Index

MCI, Metacognitive Index

SRS, Social Responsiveness Scale

FSIQ, full-scale intelligence quotient

SD, standard deviation

SPSS, Statistic Package for Social Science

SEM, structural equation model

CFA, confirmatory factor analysis

RMSEA, Root Mean Square Error of Approximation

CFI, Comparative Fit Index

GFI, Goodness-of-fit

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Sun Yat-sen University, and signed written informed consent was obtained before the questionnaire was completed.

Consent for publication

Written informed consent for publication was obtained from all participants.

Availability of data and materials

This data underlying this article will be shared on reasonable request to the corresponding author.

Competing interests

The authors declare that they have no conflict of interest.

Funding

This study was supported by the Key-Area Research and Development Program of Guangdong Province (grant number 2019B030335001), Science and technology planning project of Guangzhou (general project), China (202201011158), National Social Science Foundation of China (grant number 20&ZD296). We declare that we have no potential conflicts of interest.

Authors' contributions

Tingfeng Gu: Conceptualization, Methodology, Software, Formal analysis, Investigation, Writing—original draft, and Writing—review and editing. Chengkai Jin: Conceptualization, Methodology, Software, and Writing—review and editing. Lizi Lin: Data Curation, Resources, and Supervision. Xin Wang: Data Curation and Project administration. Xiuhong Li: Data Curation and Project administration. Jin Jing: Methodology, Resources, Writing—review and editing, Supervision, and Funding acquisition. Muqing Cao: Conceptualization, Methodology, Resources, Writing—review and editing, Supervision, and Funding acquisition.

Acknowledgements

We thank all the children and their families for participating in the study. We also thank the co-workers that contributed to the study.

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No competing interests reported.

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The association of motor coordination impairment and social communication deficits in children with autism is mediated by executive function

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Abstract

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Introduction

Methods

Participants and data collection procedure

Motor coordination assessment

Executive function assessment

Social communication function assessment

Covariates and cognition assessment

Statistical analysis

Results

Demographic data

Correlation analyses

Structural Model

Structural model without mediators

Structural model with mediators

Discussion

Conclusion

Abbreviations

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References

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Supplementary Files

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