Neuromotor Task Training in Autistic Children With Motor Difficulties

Autism spectrum disorder is frequently associated with motor difficulties that may affect autonomy, participation in daily activities, and quality of life. These difficulties may involve balance, coordination, motor planning, object manipulation, fine motor skills, gross motor skills, or the learning of functional motor skills. This study evaluates the use of Neuromotor Task Training (NTT), a task-oriented rehabilitation approach, in autistic children with motor difficulties.

The study will include 12 autistic children aged 6 to 10 years who present motor difficulties. Participants will be recruited in the context of their usual clinical care pathway, including child and adolescent mental health or medico-psychological services. Inclusion will require a diagnosis of autism spectrum disorder, an intelligence quotient of 70 or above, and motor difficulties documented through clinical assessment and standardized motor assessment. Standardized assessments may include the Movement Assessment Battery for Children, Third Edition (MABC-3), and the Developmental Coordination Disorder Questionnaire (DCD-Q), in order to document the presence and severity of motor difficulties in daily life.

The study uses a concurrent multiple-baseline single-case experimental design replicated across three successive cohorts of four participants. This design is well suited to the evaluation of individualized rehabilitation approaches in small clinical samples. Each participant serves as their own control through repeated measurements across successive study phases. Within each cohort, the introduction of the intervention will be staggered across participants to provide multiple opportunities to demonstrate an intervention effect at different points in time. Replication of the experimental procedure across three independent cohorts is intended to strengthen the internal validity of the study.

The study procedure includes four main stages: inclusion and initial assessment, pre-intervention baseline, intervention, and post-intervention follow-up.

During the inclusion and initial assessment stage, eligibility criteria will be checked. Motor difficulties will be documented using standardized motor tools and clinical assessment. The child's ability to understand and participate in the motor training sessions will also be considered. Written informed consent will be obtained from the child's legal representative(s), and the child's assent will be sought whenever possible according to age and level of understanding.

The pre-intervention baseline phase will last approximately 6 to 9 weeks. During this phase, the child, family, and researcher or therapist will identify one meaningful functional motor skill that is difficult for the child in daily life. Examples may include catching a ball, jumping rope, putting on a coat, cutting with scissors, or another functional task relevant to the child's autonomy and participation. The selected target skill will be defined in measurable terms so that repeated performance assessments can be conducted throughout the study.

During the baseline phase, the primary outcome will be assessed once weekly. In accordance with the What Works Clearinghouse single-case design standards (Version 5.0), each participant will complete a minimum of six baseline assessments. Within each cohort, introduction of the intervention will be staggered across participants, resulting in baseline phases of approximately 6, 7, 8, and 9 weeks, respectively. Baseline measurements will continue for participants who have not yet entered the intervention phase. Individualized goals will also be formalized using Goal Attainment Scaling (GAS), and a sensory profile assessment will be administered to identify sensory preferences, sensitivities, or aversions that may influence the child's engagement, learning conditions, response to feedback, or tolerance of the practice environment.

The intervention phase will consist of 10 Neuromotor Task Training sessions. NTT is a task-oriented rehabilitation approach based on the direct practice of meaningful motor tasks. The intervention focuses on a functional motor skill selected according to the child's needs, family priorities, and clinical assessment. The therapist analyzes the task requirements, including spatial, temporal, sequential, coordinative, and environmental demands. The therapist also analyzes the child's performance in order to identify factors that may limit successful task execution.

During the NTT sessions, task constraints, environmental conditions, and individual support will be adjusted progressively. These adaptations may include changes in distance, speed, object size, spatial organization, task complexity, attentional demands, or environmental constraints. Instructions, demonstrations, practice structure, and feedback will be adapted according to the child's stage of motor learning and sensory profile. Feedback may focus on the result of the action, the quality of movement, or environmental cues that help the child adjust their performance. The aim is to support the emergence, stabilization, and generalization of more efficient motor coordination.

Repeated motor performance measurements will be collected during each intervention session. The performance metric will be selected according to the target skill and will be objective, functional, and sensitive to change. Examples may include the number of successful trials, time needed to complete the task, accuracy, or another task-specific quantitative indicator. These repeated measurements will make it possible to describe each participant's learning trajectory over time.

To limit assessment bias, motor performance measures may be video-recorded and rated secondarily by an external outcome assessor who is not involved in the training sessions. When feasible, the assessor will be masked to the study phase. This procedure is intended to improve the reliability of outcome assessment while taking into account the practical constraints of a rehabilitation study conducted in a clinical setting.

After the 10-session intervention phase, a post-intervention follow-up phase will be conducted for approximately 3 to 5 weeks. During this phase, repeated performance measurements will continue without active NTT training on the target skill. This phase will allow the researchers to examine whether the acquired motor performance is maintained after the intervention. The follow-up phase will also help document retention and possible generalization of the motor skill to daily-life contexts, such as home, school, or other relevant environments.

Goal Attainment Scaling will be rated after completion of the 10-session intervention and again at the end of the 5-week follow-up phase to quantify the extent to which the individualized functional goal has been achieved and maintained. The MABC-3 will be used at baseline to characterize participants' motor difficulties and will not constitute a pre-specified intervention outcome.

The primary focus of the study is the change in performance on the individualized functional motor skill across baseline, intervention, and follow-up phases. Visual analysis of repeated performance data will be used to examine level, trend, slope, stability, immediacy of effect, overlap between phases, and maintenance of gains. Statistical analyses adapted to single-case experimental designs may also be used, including non-overlap indices such as Tau-U or modified Tau-U, in order to quantify the magnitude of change between phases.

Secondary and exploratory analyses may examine individual learning profiles, variability of response to NTT, maintenance of gains, and the possible contribution of sensory profile characteristics to intervention adaptation. When appropriate, exploratory analyses may also use dimensional reduction or clustering approaches to describe patterns of response across participants. These analyses will remain exploratory and will be interpreted with caution because of the small sample size and individualized nature of the intervention.

This study is designed to provide clinically relevant information about the implementation of task-oriented motor rehabilitation in autistic children with motor difficulties. It aims to document whether NTT may help improve meaningful functional motor skills, how performance changes over time, and under which clinical conditions this approach may be adapted to the needs of autistic children.