Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-022-05858-8

ORIGINAL PAPER

Differences in Praxis Errors in Autism Spectrum Disorder Compared

to Developmental Coordination Disorder
Gabriel Abrams1,2 · Aditya Jayashankar1,2 · Emily Kilroy1,2 · Christiana Butera1,2 · Laura Harrison1,2 · Priscilla Ring1,2 ·
Anusha Houssain1,2 · Alexis Nalbach1,2 · Sharon A. Cermak2 · Lisa Aziz‑Zadeh1,2 

Accepted: 30 November 2022

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
This study aimed to better understand how autism spectrum disorder (ASD) and developmental coordination disorder
(DCD) differ in types of praxis errors made on the Florida Apraxia Battery Modified (FAB-M) and the potential relation-
ships between praxis errors and social deficits in ASD. The ASD group made significantly more timing sequencing errors
in imitation of meaningful gestures, as well as more body-part-for-tool errors during gesture-to-command compared to the
other two groups. In the ASD group, increased temporal errors in meaningful imitation were significantly correlated with
poorer affect recognition and less repetitive behaviors. Thus, in ASD, aspects of imitation ability are related to socioemo-
tional skills and repetitive behaviors.

Keywords  ASD · DCD · Dyspraxia · Praxis · Imitation · Gesture

Introduction Mody et al., 2016; Williams et al., 2004). A better under-

Autism Spectrum Disorder (ASD) is a pervasive develop-
mental disorder characterized by deficits in social commu-
nication and emotional regulation, as well as restricted and
repetitive behaviors (National Institute of Mental Health,
2022). A growing body of research suggests a high prev-
alence of motor deficits in individuals with ASD (Bhat,
2020; Chukoskie et  al., 2013; Edwards, 2014; Fournier
et al., 2010; Green et al., 2009; Hannant et al., 2018; Hil-
ton et al., 2012; Jansiewicz et al., 2006; Ming et al., 2007;
standing of motor deficits that may be particular to ASD
may improve early diagnosis, especially as motor deficits
are much easier to test than social and emotional deficits
(Dowell et al., 2009). Further, by understanding the rela-
tionship between social and motor deficits, we may better
understand the underlying etiology of ASD. Indeed, in ASD
it has been noted that some praxis skills, such as imitation
ability, may be related to social impairments that are the
core of the diagnosis, including joint attention (Bottema-
Beutel et al., 2019; Carpenter et al., 2002; Dadgar et al.,

* Lisa Aziz‑Zadeh Anusha Houssain

lazizzad@usc.edu ahossain@usc.edu
Gabriel Abrams Alexis Nalbach
gabrams@usc.edu analbach@usc.edu
Aditya Jayashankar Sharon A. Cermak
jayashan@usc.edu cermak@usc.edu
Emily Kilroy 1
Brain and Creativity Institute, University of Southern
ekilroy@usc.edu
California, 3620A McClintock Avenue, Los Angeles,
Christiana Butera CA 90089, USA
cbutera@usc.edu 2
Mrs. T. H. Chan Division of Occupational Science
Laura Harrison and Occupational Therapy, University of Southern
lauraloesch09@gmail.com California, 1540 Alcazar Street, Los Angeles, CA 90089,
USA
Priscilla Ring
pring@usc.edu

13
Vol.:(0123456789)

2017; Ingersoll & Schreibman, 2006; Rogers et al., 2003),
empathy skills (Adornetti et al., 2019; Dowell et al., 2009;
McAuliffe et al., 2017; Mostofsky et al., 2006), social learn-
ing by imitation (Dziuk et al., 2007), functional and sym-
bolic play (Libby et al., 1997; Stone et al., 1997; Vivanti
et al., 2013), social reciprocity (McDuffie et al., 2007; Young
et al., 2011), cooperation (Colombi et al., 2009), and theory
of mind (ToM; Perra et al., 2008). Further, imitation skills
have been correlated with autism severity (Gizzonio et al.,
2015; Ingersoll & Meyer, 2011; Pittet et al., 2022; Rogers
et al., 2003; Zachor et al., 2010). Here we aim to understand
motor deficits in ASD, specifically by looking at errors made
during a measure of praxis skills compared to a group with
developmental coordination disorder (DCD), as well as the
relationship between praxis errors and social deficits in ASD
and DCD. Here, we refer to motor performance skills as
controlled and goal-directed actions measuring skills such as
fine motor, ball, and balancing using quantitative metrics of
frequency, speed, etc. (Harris et al., 2015; Henderson et al.,
2007). By contrast, we refer to praxis as representational or
non-representational imitation and gesture production, with
or without the use of tools (Ayres, 1989; Mostofsky et al.,
2006)
Developmental Coordination Disorder
Many of the motor deficits commonly seen in ASD also are
seen in DCD, also known as dyspraxia (Gibbs et al., 2007;
Kilroy et al., 2021). A DCD diagnosis is based on impair-
ments in dexterity, limb speed, and gross and fine motor
skills that reduce one’s ability to engage in activities of
daily living and achieve academically (American Psychiatric
Association, 2013; Blank et al., 2019; Chang & Yu, 2016).
While about 30% of the DCD population shows social dif-
ficulties on a social measure commonly used with ASD
(Social Responsiveness Scale (SRS); Kilroy et al., 2021),
these deficits are not part of the diagnostic criteria and com-
monly are noted as secondary impairments stemming from
exclusion from social activities requiring motor coordina-
tion (i.e., sports teams, participation in musical ensembles,
arts and crafts groups; Tal Saban & Kirby, 2019). However,
a moderate correlation between motor performance and
emotional cognition has been found in DCD (Vatandoust &
Hasanzadeh, 2018), and an increasing amount of data indi-
cate that social deficits may be more prominent in DCD than
previously thought (Blank et al., 2019; Dewey et al., 2002;
Karras et al., 2019; Kilroy et al., 2022; Sumner et al., 2016).
In addition, with regard to executive functions, children
with DCD perform worse than children with ASD on tasks
involving visuospatial working memory (such as sillhouette
detection, position discrimination, and cube analysis), while
children with ASD perform worse than children with DCD
13
Journal of Autism and Developmental Disorders
on tasks that require verbal working memory (Alloway &
Temple, 2007; Alloway et al., 2008).
Comparing Motor and Praxis Skills Between ASD
and DCD
Performance on motor skills, such as balance, manual dex-
terity, and ball skills, are generally equally poor in ASD
and DCD groups compared to typically developing groups
(TD; Caçola et al., 2017; Kilroy et al., 2022). By contrast,
praxis performance encompassing skilled limb gestures
(e.g., gesture-to-command, tool use, imitation; Crucitti
et al., 2019), often differs between ASD and DCD groups,
with ASD performing worse (Dewey et al., 2007; Kilroy
et al., 2022). Dewey et al. (2007) found that only the ASD
group (compared with DCD, DCD+ ADHD, and TD groups)
showed impairments in imitation of meaningful actions and
gesture-to-command. Specifically, when looking at types
of errors made, during gesture-to-command, children with
ASD made significantly more errors in delay, distortion, ori-
entation, body-part-as-object and incorrect actions. During
imitation, children with ASD made significantly more errors
in extension, distortion, orientation, and body-part-as-object
(Dewey et al., 2007). These results are consistent with more
recent studies by our group and others showing that children
with ASD produce significantly more errors when imitating
gestures and performing gestures from verbal commands
than their TD counterparts (Gizzonio et al., 2015; Kilroy
et al., 2022) and that accuracy in gesture-to-command and
imitation of meaningful gestures is significantly poorer in
ASD compared to DCD groups (Kilroy et al., 2022). The
latter results for praxis accuracy remain even after control-
ling for social skills, theory-of-mind (ToM) skills, IQ, sex,
and age (Kilroy et al., 2022). Further, while motor skills
interact with praxis skills in the DCD group (Kilroy et al.,
2022), in the ASD group, deficits in praxis performance do
not seem to be accounted for by deficits in motor coordina-
tion, perception, or basic motor control (Dewey et al., 2007;
Gizzonio et al., 2015; Kaur et al., 2018; Kilroy et al., 2022).
Here, we aim to better understand praxis deficits in ASD
by directly investigating differences in error type in praxis
skills between ASD, DCD, and TD groups. This builds
upon our recent work that focused on accuracy comparisons
between the three groups (Kilroy et al., 2022) and other prior
work which investigated error types without also looking at
relations to social skills within groups (Dewey et al., 2007).
Here, we consider temporal, spatial, content, and body-part-
for-tool errors using the Florida Apraxia Battery, modified
for children (FAB-M), which consists of subsections includ-
ing gesture-to-command, tool use, and imitation. We predict
that groups would significantly differ in the proportions of
each error type each group would present, even after con-
trolling for age and IQ. Based on our prior work (Kilroy
Journal of Autism and Developmental Disorders
et al., 2022), we expected more errors in the ASD group
compared to DCD and TD groups for gesture-to-command
and imitation of symbolic and pantomimed gestures. Specifi-
cally, given data indicating significant visuospatial memory
deficits in DCD (Alloway et al., 2008), we hypothesized
that overall, the DCD group would present a significantly
higher proportion of spatial errors across all praxis measures
compared to the TD and ASD groups. Furthermore, due to
significant difficulties in conceptual reasoning found in ASD
children (Mostofsky et al., 2006), we hypothesized that ASD
participants would produce more conceptual motor errors
(body-part-for-tool and content errors) compared to DCD
and TD participants.
Relationship Between Social and Motor Skills
As described above, praxis skills have been posited to be
related to social skills in ASD. However, the relationship
between specific deviations in both praxis skills and social
skills is less understood in ASD and DCD. Previous research
has reported significant correlations between the error
types in pantomimed gestures and the severity of social and
emotional ASD deficits also have been reported (Gizzonio
et al., 2015), though to our knowledge, similar comparisons
between error types and social skills in DCD have not been
made despite findings of elevated disturbances in social
skills (Kilroy et al., 2022; Sumner et al., 2016). Indeed, prior
research has shown that children with probable DCD per-
formed poorly on tasks involving recognition of emotional
facial expressions (Sumner et al., 2016). Moreover, children
with DCD showed differences compared to ASD and TD in
attending to socially relevant stimuli (Sumner et al., 2018).
Further, motor ability was a significant predictor of social
behavior in DCD [using the social competence scale of the
Child-Behavior Checklist (CBCL)], even when control-
ling for emotion recognition and visual-spatial organiza-
tion (Cummins et al., 2005). However, when considering
overall accuracy ratings of praxis skills as measured by the
FAB-2, our previous work showed no relationships between
social and praxis skills in ASD or DCD groups (Kilroy et al.,
2022). Nevertheless, error type may be a more specific
marker, compared to accuracy, for exploring such relation-
ships. Thus, to our knowledge, for the first time, here we
investigate relationships between social skills and error types
in praxis skills in both ASD and DCD groups. To reduce the
number of comparisons, we focus on praxis skills known
to be most strongly affected in ASD compared to DCD,
imitation of meaningful gestures, and gesture-to-command
(Kilroy et al., 2022). We predict correlations between these
praxis skills and social skills, ToM skills, affect recognition,
and autism severity (including measures of restricted and
repetitive behaviors).
Materials and Methods
Participants
Ninety-five children (aged 8–17) participated in the current
study. This sample is identical to that in Kilroy et al., 2022)
with the exception of 1 ASD participant removed for incom-
plete data. Participants were recruited through social media,
and outreach to clinics, public schools, and private schools
in the greater Los Angeles area. This study was part of a
larger study that included brain imaging components (Kilroy
et al., 2021). Inclusion criteria for all participants included:
(1) right-handed as measured by a modified Oldfield ques-
tionnaire (1971); (2) English speaking with at least 1 par-
ent proficient in English, (3) no history involving a loss of
consciousness > 5 min; (4) born at or after 36 weeks of ges-
tation; and (5) an IQ score ≥ 80 on the Full Scale 4 [FSIV-
IQ] or Verbal Comprehension Scale [VCI-IQ] assessed by
the Wechsler Abbreviated Scale of Intelligence 2nd Edition
(WASI-2; Wechsler, 2011); (6) no other neurological or psy-
chiatric diagnosis except for attention-deficit-hyperactivity-
disorder (ADHD) and/or anxiety disorder in the ASD and
DCD groups. Group characteristics can be seen in Table 1.
TD Group
The TD group consisted of 35 participants (11 female and
24 male). Additional inclusion criteria for the TD group
included: (1) a T-score < 65 on the Conners 3AI-Parent
report (Conners 3); (2) at or above the 25th percentile on
the Movement Assessment Battery for Children (MABC-2);
(3) a T-score > 60 on the Social Responsiveness Scale 2nd
Edition (SRS-2); (4) no DCD diagnosis or probable dysp-
raxia based on the Developmental Coordination Disorder
Questionnaire (DCDQ), and no prior concerns of ASD.
ASD Group
The ASD group consisted of 32 participants (7 female and
25 male) Additional inclusion criteria included: (1) a pre-
vious diagnosis of ASD and meeting criteria for an ASD
diagnosis based on their scores on the ADOS-2 (adminis-
tered by research certified assessor and reviewed by a cli-
nician); (2) no other neurological or psychiatric disorders
with the exceptions of ADHD and anxiety disorder. Based
on parental reports 31 participants had clinical concerns
of ADHD and 6 for Anxiety disorder. Eleven ASD par-
ticipants were prescribed and actively taking stimulants
medications for ADHD and/or anxiety and 1 individual
was on an antidepressant.
13
 Journal of Autism and Developmental Disorders

Table 1  Demographic variables Characteristics of evaluated group

of the study sample
Group Age FSIQ ToM subscore ADOS-2
Social Restrictive and repeti- Compari-
affect tive behavior subscore son score
subscore

TD Mean 11.90 114.94 24.79

Std. deviation 2.22 12.64 1.99
N 35.00 35.00 35.00
ASD Mean 11.89 107.69 22.81 8.31 2.55 6.41
Std. deviation 2.28 19.87 3.08 3.61 1.39 1.98
N 32.00 32.00 27.00 32.00 31.00 32.00
DCD Mean 11.96 110.68 25.04
Std. deviation 2.35 17.04 2.49
N 28.00 28.00 28.00

No outliers (beyond 3 SD) were detected in our study sample for all variables

Probable DCD Group parent-report questionnaires (repetitive behavior question-

The probable DCD group consisted of 28 participants (11
female and 17 male). Additional inclusion criteria included:
(1) scoring at the 16th percentile or lower on the MABC-2;
(2) no other neurological or psychiatric disorders with the
exceptions of ADHD and anxiety disorder; (3) no first-degree
relatives with an ASD diagnosis, and no concerns of ASD
diagnosis. Additionally, if the participant’s SRS-2T-score was
over 76 (“severe risk” for ASD) the participant was excluded
from the DCD category. Five DCD participants had SRS-2
scores between 65 and 75 (“moderate risk”); however, none
met ADOS-2 criteria for an ASD diagnosis and were not
excluded from the sample. Based on parental reports, there
were 21 participants with concerns of ADHD and three par-
ticipants with concerns of Anxiety. Four DCD participants
were taking prescribed psychotropic medications for ADHD
and/or anxiety (see Table 1).
Procedures
After signing the consent and assent forms, all participants
filled out demographic and handedness questionnaires. Par-
ticipants with ASD then completed the ADOS. All partici-
pants completed IQ measures, social affect and theory of mind
measures, trait empathy and, and FAB-M next with a trained
RA. They then performed the MABC-2 with a trained RA.
Simultaneously, in a separate room, parents completed all
naires, social responsiveness scale, anxiety, AHDH measure).
Motor Measures
Praxis
Praxis skills were measured by the Florida Apraxia Bat-
tery, modified for children (FAB-M; Mostofsky et al., 2006),
which consists of Tool Use (TU), Gesture-to-Command
(GTC), and Imitation (IMI). For each of the three sections,
the skilled gestures included Pantomime actions (actions that
involve the subject imagining the action and performing it,
such as hammering nails into a wall in front of them). IMI
and GTC further included Symbolic actions (actions that
represent more abstract concepts, such as “Show me how
you tell someone to be quiet”). Pantomime and Symbolic
actions together are considered “Meaningful Gestures” and
have a communicative intent. The IMI section additionally
included a subsection of “Meaningless Gestures” (novel
movements with no explicit communicative meaning). In
TU, the participants are provided with 17 different tools and
asked to show how they would use each tool. In GTC, the
participants were verbally instructed to perform 25 different
gestures:17 pantomime questions and 8 symbolic items. In
IMI, the participants are instructed to imitate 34 gestures
shown to them by the administrator: 17 pantomime, 8 sym-
bolic, and 9 meaningless gestures. The pantomime actions

13
Journal of Autism and Developmental Disorders

Table 2  Sections and subsections of the FAB-M

Gesture-to-command (GTC) Imitation (IMI) Tool use (TU)

Pantomime (# of items = 17) Pantomime (# of items = 17) Pantomime (# of items = 17)

e.g., The administrator tells
the participant to act out the
use of a hammer and nail
Symbolic (# of items = 8)
e.g., The administrator tells
the participant to act out as if
they were saluting
e.g., The administrator acts out the use of a hammer and e.g., The administrator gives the participant a toy
nail and the participant must copy it hammer and asks him or her to show them how they
would use the tool
Symbolic (# of items = 8)
e.g., The administrator salutes and the participant must
copy it
Meaningless (# of items = 9)
e.g., The administrator makes meaningless arm circles,
and the participant must copy it

Table 3  Breakdown of all possible error types in the FAB-M

Error type Errors Description

Spatial Amplitude (A) Subject shows irregularity in the height and/or width of the motion (in the form of an
increase or decrease)
Internal configuration (IC) Subject does not position hand in the proper way to use the tool
External configuration (EC) Subject's tool movements do not align properly with the expected relationship between the
tool and object
Movement (M) Subject shows movement of the wrong joints when performing the task
Temporal Timing (T) Subject shows irregular timing in their action
Sequence (S) Subject does not follow the sequence of a gesture (can be the deletion or addition of parts of
a sequence)
Occurrence (O) Subject performs too little or too few cycles of the action
Content Concretization (C) Subject performs a pantomime action on an object unrelated to the task
Preservative (P) Subject performs a movement that uses parts or all the previous movement
Related (R) Subject performs a movement that is related to the movement solicited, but not the actual
movement
Non-related (N) Subject performs a gesture that was not solicited
Hand (H) Subject uses their hand in place of the imagined tool
Body part for tool Body Part for Tool (BPT) Subject uses a body part as a tool
Other No response (NR) Subject did not respond
Unrecognizable response (UR) Subject's response was unable to be recognized

in each category are identical actions amongst TU, GTC,
and IMI, (see Table 2).
Video recordings of each participant were collected at a
front-facing and over-the-shoulder angle in respect to the
participant for the duration of the assessment. After the
assessment was completed, three occupational therapists
(OTs) reviewed and scored the assessment. Each item was
either deemed correct or incorrect with a specified error
type as outlined by Gizzonio et al. (2015) (see Table 3).
An agreement of 80% or higher was achieved between two
raters with the third rater acting as a tiebreaker. For items
where participants performed multiple error types, all types
of errors were recorded (this occurred in 12.22% of TU tri-
als, 1.39% of GTC, 15.19% of IMI).
Calculation of errors on the FAB-M followed Rothi
and Heilman (2014), who categorized each error into 1 of
4 domains: spatial errors, temporal errors, content errors,
and other errors. We additionally included a separate fifth
domain, body-part-for-tool (BPT), following Gizzonio et al.
(2015), who removed these from the spatial error section. A
description of all possible errors is provided in Table 3. Sec-
tions and subsections of the FAB-M are broken down into 3
sections, GTC, IMI, and TU. All three sections can further
be broken down into subsections. All three share the same 17
pantomime questions, GTC and IMI share 8 symbolic ques-
tions, and IMI has an additional nine meaningless questions.

13

Other Behavioral, Socio‑emotional, and Cognitive
Measures
IQ
The Wechsler Abbreviated Scale of Intelligence (WASI-II;
Wechsler, 2011) is a measure of intelligence normed for ages
6–90 and contains four subtests including Block Design,
Vocabulary, Matrix Reasoning, and Similarities. Verbal
Comprehension Index (VCI) consists of Vocabulary and
Similarities subtests and Perceptual Reasoning Index (PRI)
consists of Block Design and Matrix reasoning subtests.
Measures of Autism Severity
Participants with a previous diagnosis of ASD, or a sus-
pected diagnosis of ASD were given additional assessments
to confirm the diagnosis and determine the severity of their
deficits. The ADOS-2 is a diagnostic exam that provides
standardized measures of a child’s social affect, ability to
communicate, and restricted and repetitive behaviors. Addi-
tionally, the diagnostic tool provides a comparison severity
score ranging from 1 to 10 (10 being the highest; Lord et al.,
2012). The ADI-R (Lord et al., 1994) is a clinical diagnostic
instrument for assessing autism. It is a structured interview
with the parent with open-ended questions and scored across
three domains: Language/Communication (LC), Reciprocal
Social Interactions (RSI), and Restricted, Repetitive, and
Stereotyped Behaviors (RRB). In this study, RSI was used as
our index of autism social severity since we were primarily
interested in social severity.
Restricted and Repetitive Behaviors
The Repetitive Behavior Scale-Revised (RBS-R) is a vali-
dated 43-item questionnaire that measures restricted and
repetitive behaviors in children, adolescents, and adults
with ASD, appropriate for ages 2–18 years (Hooker et al.,
2019; Schertz et al., 2016). Parents rate items on a 4-point
Likert scale ranging from (0) “behavior does not occur” to
(3) “behavior occurs and is a real problem” within the past
month (Lam & Aman, 2007). Bodfish et al. (1999) found the
inter-rater reliability of the 6 subscales (Stereotyped Behav-
ior, Self-injurious Behavior, Compulsive Behavior, Ritual-
istic Behavior, Sameness Behavior, and Restricted Behav-
ior) to be between 0.55 and 0.78, and test–retest reliability
between 0.52 and 0.96. Raw scores are added to achieve
subscale scores, and the sum of subscores is used as the total
score. Previous research recommends focusing on the sub-
scores, as opposed to the total score, to capture the nuances
of such behaviors (Mirenda et al., 2010; Scahill et al., 2014).
13
Journal of Autism and Developmental Disorders
Attention Deficit Hyperactivity Disorder
Both the parent measure and the child self-report measure of
the Conners 3rd edition ADHD Index (Conners, 2008) were
used as two separate scores.
A Developmental NEuroPSYchological Assessment
(NEPSY‑II)
Each participant was assessed using the Social Perception
domain of the Developmental NEuroPSYchological Assess-
ment 2 (NEPSY-II; Korkman et al., 2007). The Affect Rec-
ognition (AR; 35 items) and Theory of Mind (ToM; 21
items) subtests within the social perception domain were
utilized. The ToM subtest contains a verbal and contextual
score. The sum of raw scores from each subtest are used to
inform a percentile rank, scaled scores, and a social percep-
tion total score. Higher scores indicate greater ability.
Interpersonal Reactivity Index (IRI)
Each participant was administered the IRI to quantify empa-
thy (Davis, 1983). The assessment is broken down into four
traits that encompass empathy: Perspective Taking (PT; the
ability to take on other perspectives), Fantasy (F; the extent
to which one identifies with fictitious characters), Empathic
Concern (EC; the level of concern one has for others), and
Personal Distress (PD; negative feelings felt in response to
the negative circumstances of another person). The assess-
ment generates PT, F, EC, and PD subscores. Note, the F
subscale has previously been reported to have reliability
concerns (Cox et al., 2012) and therefore results should be
considered carefully.
Statistical Measures
Preliminary Analysis
Upon completion of data collection, the sample data was
assessed for potential outliers. From the original sample of
96 participants, 1 ASD subject was removed because they
were missing their ADOS diagnostic scores. FSIQ, ToM, and
ADOS scores were evaluated for outliers (3 standard devia-
tions from their group average). No participants met these
criteria. Additionally, a one-way ANOVA was conducted
on both Age and FSIQ, with group as a factor, to determine
the homogeneity of these variables within each group. Both
FSIQ and Age (F(2,92) = 1.610, p > 0.2 and F(2,92) = 0.009,
p > 0.9 respectively) showed no statistical significance, sug-
gesting that both variables were homogenous within each
group. However, after running a preliminary ANCOVA
with Age, Sex, and FSIQ as covariates, both Age and FSIQ
(and not Sex) were found to be significantly associated with
Journal of Autism and Developmental Disorders
performance on the praxis assessment (p < 0.005 for both).
For this reason, both variables were added to our model as
covariates for the remainder of the analysis.
Performance on each praxis assessment was measured
by the participant’s Error Performance (EP) in each section
and subsection. In some instances, not all participants were
administered all items (i.e., request to end session early or
missed item by administrator). EP was measured as a ratio of
incorrectly performed questions to the total number of ques-
tions administered for each section/subsection. For example,
a participant who performed two errors in GTC out of 17
administered Pantomime items would have a GTC Panto-
mime EP score of 2/17 or 0.118, however, a participant who
performed 2 errors in the GTC out of 15 administered items
would have an EP score of 2/15 or 0.133. EP scores were
calculated for each section/subsection combination.
Individual Section Analysis
A repeated measures ANCOVA (rmANCOVA) was con-
ducted with group (TD, DCD, & ASD) as the between-sub-
jects factor and the overall performance by subsection as the
within-subjects factor. This analysis was conducted for all
three sections of the praxis assessment individually. We fol-
lowed up this analysis by examining the overall performance
of each error type. Error type performance (SPAT, TEMP,
BPT, and CONTENT) was added as an additional within-
subjects variable. Analyses were conducted separately by
section.
Pantomime Trial Analysis
Additional analysis was done on the EP of pantomime
actions across all 3 sections within each group (ASD, DCD,
TD). This was completed to compare, within-group, per-
formance of the same pantomimed movements when given
different instructions (Tool Use, Gesture-to-Command, and
Imitation). An rmANCOVA was conducted with section EP
as the within-subject factor (with 3 levels: GTC, IMI, TU)
and group as a between-subjects factor. If the main-effects
were significant, post-hoc analyses with a Bonferroni cor-
rection were performed in order to understand pairwise com-
parisons of EP between each group.
Correlation Analysis
A Pearson correlation coefficient was calculated between
overall performance scores on the Imitation and Gesture-
to-Command subsections of FAB-M, for error types that
showed differences between ASD and DCD (determined
by the analyses above) and severity of behavioral defi-
cits for ASD and DCD participants. ASD severity was
operationalized by scores on the ADOS-2 and ADI-R RSI.
We further correlated gesture errors with scores on the SRS-
2, NEPSY-II subtests (ToM and Affect Recognition), IRI,
and RBS-R for both ASD and DCD participants. Of our 32
ASD participants, 5 were removed from the correlation with
NEPSY-II due to missing scores, and 1 was removed from
the correlation with the ADOS-2 due to a missing score.
Results
Between Group Analysis of Errors on FAB‑M
Components
Tool Use (TU) Analysis
Overall, the ASD and DCD groups performed a signifi-
cantly larger proportion of total TU errors compared to the
TD group (ps < 0.001; see full results in Table 4). Nota-
bly, the DCD group had significantly more temporal errors
compared to the TD group (p = 0.009), and the ASD group
had significantly more content errors than the TD group
(p = 0.002). However, there were no significant differences
in errors between ASD and DCD groups. When we control
for age, and total FSIQ there was no change in the signifi-
cance of the results (all p < 0.05; see Table 5).
GTC Analysis
The ASD group performed significantly more GTC errors
than the TD group (p < 0.001; See Fig. 1a and Table 4).
Specifically, the ASD group performed significantly more
body-part-for-tool errors than either the TD or the DCD
group (p < 0.001 and p = 0.003, respectively; See Fig. 2).
When we control for age, and total FSIQ there was no
change in the significance of the results (all p < 0.05; see
Table 5).
IMI Analysis
The IMI section was subdivided into pantomime, sym-
bolic, and meaningless gestures. Overall, as Fig. 1b shows,
the ASD group produced a significantly larger proportion
of imitation symbolic errors than both the DCD and TD
groups (p = 0.006 and p < 0.001 respectively; see Table 4),
while the DCD group performed significantly more errors
than the TD group (p = 0.011). Notably, the ASD group per-
formed a significantly larger proportion of temporal errors
in both the pantomime and symbolic subsections compared
to the TD and DCD groups (pantomime: p =  < 0.001 and
p = 0.012 respectively; symbolic: p = 0.006 and p = 0.013;
See Fig. 3). In a post-hoc analysis, we found that temporal
13
 Journal of Autism and Developmental Disorders

Table 4  Results of significant statistical comparisons (ANOVA) between groups without including age and IQ as covariates
Comparison ANOVA statistics Pairwise group comparisons
2
F-statistic (2, 92) p value η ASD-TD δ p value DCD-TD δ p value ASD-DCD δ p value

TU OP 27.842  < 0.001 0.377 0.258*  < 0.001 0.177*  < 0.001 0.08 0.104

TU Temp 4.808 0.01 0.095 0.022 0.18 0.036* 0.009 − 0.014 0.713
TU content 6.596 0.002 0.125 0.09* 0.002 0.063 0.059 0.027 0.945
GTC OP 10.135  < 0.001 0.181 0.157*  < 0.001 0.077 0.106 0.08 0.1
GTC pantomime BPT 8.886  < 0.001 0.162 0.071*  < 0.001 0.005 1 0.065* 0.003
IMI symbolic OP 20.831  < 0.001 0.312 0.26*  < 0.001 0.125* 0.011 0.135* 0.006
IMI pantomime Spat 19.14  < 0.001 0.294 0.249*  < 0.001 0.188*  < 0.001 0.061 0.523
IMI pantomime Temp 9.972  < 0.001 0.178 0.067*  < 0.001 0.019 0.706 0.048* 0.012
IMI symbolic Temp 6.338 0.003 0.121 0.052* 0.006 0.002 1 0.05* 0.013
Transitive trials OP 23.3  < 0.001 0.336 0.237*  < 0.001 0.155*  < 0.001 0.082 0.09
Transitive trials Spat 21.364  < 0.001 0.317 0.188*  < 0.001 0.128*  < 0.001 0.06 0.171
Transitive trials Temp 7.361 0.001 0.138 0.03*  < 0.001 0.021* 0.048 0.01 0.78

All transitive trials comparisons are repeated measure ANOVAs, while the rest are one-way independent sample ANOVAs
TU tool use, GTC​ gesture-to-command, IMI imitation, OP overall performance of errors, BPT body part as a tool errors, Spat spatial errors,
Temp temporal errors, δ group mean difference
*Significant pairwise comparison

error differences between the ASD group and TD/DCD
groups were particularly driven by errors in sequencing
(p < 0.001), but not in irregular timing or performing too
many or too few occurrences. Additionally, the ASD and
DCD groups performed a significantly larger proportion of
spatial errors for pantomime imitation compared to the TD
group (ps < 0.001), but ASD and DCD groups did not sig-
nificantly differ in spatial errors. All results remained sig-
nificant when we controlled for FSIQ (or VCI) and age (see
Table 5).
Pantomime Trials Across Sections
The TD group performed significantly better on pantomime
gestures across TU, GTC, and imitation trials than both ASD
and DCD groups (ps < 0.001; see Table 4 for full results).
There was no statistically significant difference in overall
performance between ASD and DCD participants. However,
pairwise comparisons revealed that TU had the least overall
errors compared to GTC and IMI trials for all groups. Below
we include analyses for spatial and temporal errors only, as
the other error types (e.g., BPT, content) had floor effects
in some groups.
Spatial Errors Across Pantomime Trials
ASD and DCD groups showed a significantly larger pro-
portion of spatial errors across pantomime trials compared
to the TD group but did not differ significantly from each
other. All groups showed significantly fewer spatial errors
in TU compared to both IMI and GTC trials (IMI-TU
δ = 0.287; GTC-TU δ = 0.184; all ps < 0.001). For ASD and
DCD groups, there were significantly fewer spatial errors
for GTC compared to IMI pantomime trials (ASD: GTC-
IMI δ = − 0.14; p < 0.001; DCD: GTC-IMI δ = − 0.13;
p < 0.001).
Temporal Errors Across Pantomime Trials
The TD group performed significantly more temporal
errors in the GTC subsection compared to the TU subsec-
tion (GTC-TU δ = 0.023; p = 0.031). The ASD group per-
formed significantly more temporal errors during imitation
pantomime trials than in GTC or TU (IMI-GTC δ = 0.047;
p = 0.002 and IMI-TU δ = 0.05; p < 0.001, respectively). The
DCD group showed no significant differences in temporal
errors between the three subsections.
Correlations Between Praxis Measures and Other
Behavioral Measures
In the ASD and DCD groups, correlations were used to eval-
uate the relationship between intellectual, social, emotional,
and behavioral diagnostic scores and errors in each subsec-
tion of the praxis assessment that differed between ASD and
DCD groups (Symbolic Imitation Overall error performance,
Symbolic Imitation Temporal errors, and Pantomime Imi-
tation Temporal errors, Gesture-to-Command BPT errors).
There were no correlations between behavioral measures and
praxis measures in the DCD group. The results for the ASD
group can be seen in Table 6 and in scatter plots depicted

13
Journal of Autism and Developmental Disorders

Table 5  Results of significant statistical comparisons (ANCOVA) between groups after including age and IQ as covariates
Comparison ANCOVA statistics Pairwise group comparisons
2
F-statistic (2, 90) p value η ASD-TD δ p value DCD-TD δ p value ASD-DCD δ p value

TU OP 29.875  < 0.001 0.399 0.249*  < 0.001 0.174*  < 0.001 0.075 0.097

TU Temp 5.745 0.004 0.113 0.023 0.12 0.037* 0.004 − 0.015 0.609
TU content 5.309 0.007 0.106 0.077* 0.007 0.056 0.086 0.021 1
GTC OP 10.325  < 0.001 0.187 0.141*  < 0.001 0.069 0.094 0.071 0.089
GTC pantomime BPT 8.01  < 0.001 0.151 0.059* 0.002 − 0.001 1 0.060* 0.003
IMI symbolic OP 20.928  < 0.001 0.317 0.249*  < 0.001 0.120* 0.009 0.129* 0.006
IMI pantomime Spat 22.382  < 0.001 0.332 0.24*  < 0.001 0.185*  < 0.001 0.055 0.502
IMI pantomime Temp 8.369  < 0.001 0.157 0.06*  < 0.001 0.015 1 0.045* 0.016
IMI symbolic Temp 5.73 0.005 0.113 0.049* 0.011  < 0.001 1 0.049* 0.016
Transitive trials OP 26.8  < 0.001 0.373 0.222*  < 0.001 0.148*  < 0.001 0.074 0.071
Transitive trials Spat 23.695  < 0.001 0.345 0.183*  < 0.001 0.126*  < 0.001 0.056 0.151
Transitive trials Temp 6.918 0.002 0.133 0.028* 0.001 0.02* 0.046 0.008 0.902

All transitive trials comparisons are repeated measure ANCOVAs, while the rest are one-way independent sample ANCOVAs
TU tool use, GTC​ gesture-to-command, IMI imitation, OP overall performance of errors, BPT body part as a tool errors, Spat spatial errors,
Temp temporal errors, δ group mean difference
*Significant pairwise comparison

***
*** *
*** **
***
* ***
*** *

Fig. 1  Error performance on subsections FAB-M for TD, ASD, and section. C depicts error performance in the Tool Use (TU) section.
DCD Groups. A depicts error performance in Geture-to Command *p < 0.05, **p < 0.005, ***p < 0.0005
(GTC) section. B depicts error performance in the imitation (IMI)

in Fig. 4. For the ASD group, we found that for imitation of

meaningful gestures (pantomime and symbolic), temporal
errors were significantly negatively correlated with affect **
GTC BPT Error Performance

**
recognition (pantomime: NEPSY-AR Scaled; R = − 0.383, . 12

p = 0.044; symbolic: NEPSY-AR Scaled; R = − 0.465,

.10
p = 0.013). However, on visual inspection of the association
of temporal errors in symbolic imitation and NEPSY-AR .08

Scaled, we found a strong floor effect, such that most ASD .06
participants did not perform temporal errors regardless of
their affect recognition score, and the correlation was instead .04

primarily driven by one prominent high error score. Hence, .02

we focus instead on the significant correlation for panto-

.00
mime temporal errors and affect recognition. Pantomime
Temporal errors during imitation of pantomime trials
were also significantly negatively correlated with restricted Fig. 2  Body-part-for-Tool (BPT) Errors during Gesture-to-Command
and repetitive behaviors (RBS-R Sameness Subscale; (GTC) comparing between groups. **p < 0.005

13

R = − 0.429, p = 0.020). For imitation of symbolic gestures,
increased overall error performance was significantly cor-
related with less restricted and repetitive behaviors (RBS-R
Restrictive Behaviors Subscale; R = − 0.537, p = 0.002).
For Gesture-to-Command, body-part-for-tool errors were
significantly related such that higher scores on the RBS-R
Sameness Subscale were related to lower body-part-for-tool
errors (R = − 0.374, p = 0.045).
Discussion
While motor impairments are the core deficit in DCD,
there is significant evidence that motor deficits are also
common to ASD (~ 80%; Bhat, 2020; Chukoskie et al.,
2013; Edwards, 2014; Fournier et  al., 2010; Gizzonio
et al., 2015; Green et al., 2009; Hannant et al., 2018; Hil-
ton et al., 2012; Kilroy et al., 2019; Ming et al., 2007;
Mody et al., 2016; Williams et al., 2004). However, how
ASD and DCD groups differ in motor impairments has
been less studied. Prior data indicate that one source of
motor differences between ASD and DCD groups may be
in praxis skills, with ASD groups showing more praxis
impairments than DCD groups, especially in imitation
of meaningful gestures and gesture-to-command (Dewey
et al., 2007; Green et al., 2002; Kilroy et al., 2022; Miller
et al., 2021; Paquet et al., 2019; Sumner et al., 2016; Wis-
dom et al., 2007). Here we focus on prominent results in
error type between our three groups while also controlling
for age and IQ. Moreover, we discuss how different error
types are related to social functioning in ASD and DCD
groups. A main finding is that two prominent ASD symp-
tomologies, socio-emotional processing and restricted and
repetitive behaviors, correlate with pantomime imitation
and gesture-to-command errors. These findings are dis-
cussed further below.
*
***
Fig. 3  (TEMP) errors during Imitation (IMI) of Pantomime and Symbolic gestures comparing between groups. Note, the symbolic and panto-
mime sections together constitute the imitation of meaningful gestures section of the FAB-M. *p < 0.05, ***p < 0.0005
13
Journal of Autism and Developmental Disorders
Tool Use (TU)
Both ASD and DCD groups performed significantly more
TU errors than the TD group, with predominantly more spa-
tial errors than the TD group (though spatial errors were the
most common error for all groups). Compared to the TD
group, the DCD group performed more temporal errors, and
the ASD group performed more content errors. The latter
is in line with difficulties in conceptual reasoning found in
ASD children (Mostofsky et al., 2006). However, there were
no significant differences between ASD and DCD groups,
indicating that TU errors are not capable of distinguishing
between these two groups.
Gesture‑to‑Command (GTC)
Overall, for GTC, our sample performed significantly more
errors on the pantomime than the symbolic items, consist-
ent with previous studies (Gizzonio et al., 2015). This dif-
ference in performance is likely due to less motor practice
with pantomime gestures included in the assessment (e.g.,
hammering nails, painting a wall, or using a saw) as com-
pared to symbolic gestures, which they may daily perform
(e.g., giving the “O-K” symbol, “shooing” someone away).
Further, pantomime gestures may be more complicated to
perform than symbolic gestures, consistent with adult litera-
ture on apraxia, which reports greater errors in pantomime
vs. symbolic subsections (Power et al., 2010).
Further, we found that only the ASD group had signifi-
cant GTC content errors compared to the TD group. How-
ever, a post-hoc analysis showed that these differences were
no longer significant when controlling for verbal IQ. This
may reflect the strong communicative/language component
of GTC. Indeed, deficits in verbal working memory are com-
mon in youth with ASD children (Alloway et al., 2008), and
the large proportion of content errors in the GTC section
*
Journal of Autism and Developmental Disorders

Table 6  Correlations of error performance within the ASD group with behavioral variables
NEPSY ToM—verbal ToM—con- ToM—total RBS ste- RBS self- RBS RBS ritualis- RBS sameness
AR—scaled textual reotyped injurious compul- tic Bx Bx
Bx Bx sive Bx

GTC panto- − 0.135 − 0.141 − 0.091 − 0.087 0.004 − 0.027 − 0.013 − 0.114 − 0.374*
mime BPT
IMI symbolic − 0.264 − 0.143 0.009 0.052 − 0.255 − 0.239 − 0.343 − 0.294 − 0.244
OP
IMI panto- − 0.383* − 0.164 − 0.06 − 0.136 − 0.089 − 0.059 − 0.003 − 0.066 − 0.429*
mime Temp
IMI symbolic − 0.465* − 0.178 0.306 0.145 0.009 0.13 0.198 0.059 0.106
Temp
RBS restricted Bx RBS total IRI PT IRI fantasy IRI EC IRI PD ADOS social affect ADI-R RSI

GTC pantomime BPT − 0.1 − 0.141 0.147 0.236 0.181 0.279 − 0.003 − 0.001
IMI symbolic OP − 0.537** − 0.29 0.048 0.121 0.152 − 0.035 − 0.168 − 0.166
IMI pantomime Temp − 0.114 − 0.311 − 0.12 − 0.141 − 0.17 0.027 0.078 − 0.217
IMI symbolic Temp − 0.174 0.129 − 0.201 0.05 0.266 0.026 0.024 0.079

GTC​gesture-to-command, IMI imitation, OP overall performance of errors, BPT body part as a tool errors, Temp temporal errors, AR affect rec-
ognition, ToM theory of mind, Bx behaviors, PT perspective taking, EC empathic concern, PD personal distress, RSI Reciprocal Social Interac-
tion
*p < 0.05; **p < 0.01

may be due to difficulty following verbal task instructions Imitation (IMI)

for the ASD group.
Importantly, we found that the ASD group performed
significantly more BPT errors during GTC than either the
TD or DCD group, even after controlling for FSIQ (or VIQ)
and age. These results corroborate prior findings indicat-
ing that frequent production of BPT errors may be a com-
mon feature of ASD, much more so than in DCD (Dewey
et al., 2007; Fabbri-Destro et al., 2019; Gizzonio et al., 2015;
Mostofsky et al., 2006). Such BPT errors do not seem to be
linked to VIQ, and instead may be associated with other
ASD symptomatology. Indeed, there is evidence indicating
that BPT errors are not a result of production ease due to
less cognitive and motor demands than pantomimed actions,
but instead are related to increased brain activity than panto-
mimed gestures. In adults, BPT production, as compared to
pantomimed production is associated with increased bilat-
eral parietal and IFG/premotor activity, specifically in the
right parietal supramarginal gyrus (Ohgami et al., 2004).
It has been suggested that increased BPT errors following
apraxia may follow from damage to the left hemisphere
(common in apraxia) which results in increased right hemi-
sphere processing, producing BPT errors (Ohgami et al.,
2004). Whether such underlying mechanisms can also be
found to explain increased BPT errors in ASD remain to be
investigated.
Overall, the ASD group performed significantly worse than
the TD group in all IMI subsections (symbolic, pantomime,
meaningless) and significantly worse than the DCD group
in the symbolic subsection, consistent with prior studies
(Dewey et al., 2007; Kilroy et al., 2022). Moreover, the ASD
group performed a significantly larger proportion of tem-
poral errors during imitation of symbolic and pantomime
gestures than the DCD and TD groups. Thus, the ASD group
showed a significant impairment compared to both TD and
DCD, suggesting a unique deficit in temporal frequency of
imitated meaningful gestures in children with ASD. These
data are in line with previous studies that have shown that
temporal errors were among the most common error type
among children with ASD (Dewey et al., 2007; Gizzonio
et al., 2015; Mostofsky et al., 2006), and with our previous
work showing deficits in meaningful imitation (including
both pantomime and symbolic sections) are particularly
worse in ASD compared to DCD (Kilroy et al., 2021). Tem-
poral deficits may relate to problems following a particu-
lar sequence, irregular timing of imitation, not following
the sequencing of a gesture, or performing too many or too
few occurrences of the action. In a post-hoc analysis, we
found that differences between the ASD group and TD/DCD
groups were particularly driven by errors in sequencing (but
not in irregular timing or performing too many or too few

13

Fig. 4  Significant correlations between errors during gesture-to-com-
mand (GTC) or imitation (IMI) and behavioral measures in ASD. A
BPT body-part-for-tool errors during GTC pantomime trials are sig-
nificantly correlated with Repetitive Behaviors (RBS) Sameness Sub-
scale, B Errors during symbolic imitation are significantly correlated
occurrences). Thus, therapists working with individuals with
ASD may want to particularly assess for sequence errors
during screening assessments and focus on sequencing dur-
ing imitation focused interventions. Such deficits in motor
planning of imitation sequencing may also affect the utiliza-
tion of these representations in understanding other people’s
actions, as prior studies have indicated (Fabbri-Destro et al.,
2019). Whether this difficulty may be related to additional
social deficits in the ASD group is discussed further in the
next section.
Correlations of Praxis with Other Behavioral
Measures
In the ASD group, increased timing errors in imitation of
pantomimed gestures were significantly related to poorer
13
Journal of Autism and Developmental Disorders
with RBS Restricted behavior subscale, C, D Timing errors during
imitation of pantomime gestures are related to NEPSY Affect Recog-
nition and RBS Sameness subscale Note: Correlations for the DCD
group were not statistically significant and for clarity, not depicted
here
affect recognition. Indeed, the inferior frontal gyrus oper-
cularis (IFGop), a brain region that is involved in imitation
(Heiser et al., 2003) and motor rhythmic and sequencing
behavior (Sakreida et al., 2018), is also hypoactive in ASD
when observing (and imitating) facial expressions or hand
actions (Dapretto et al., 2006; Kilroy et al., 2021; Wang
et al., 2004). This result also corroborates other studies that
have found imitation ability correlates with aspects of social
ability (ToM, joint attention, functional and symbolic play,
social repricroticy, empathy; for a review, please see Vivanti
& Hamilton, 2014), as well as autism severity (Gizzonio
et al., 2015; Ingersoll & Meyer, 2011; Pittet et al., 2022;
Rogers et al., 2003; Zachor et al., 2010), as previously dis-
cussed. Further, a recent study found that praxis skills are
significantly correlated to the ability to understand errors
in other people’s actions (Fabbri-Destro et al., 2019). Here,
we add to these prior data by showing that errors in timing
Journal of Autism and Developmental Disorders
during imitation are particularly related to affect recognition.
Our data support the notion that intact motor representations
may be necessary for the ability to use one’s own motor
system to understand and interpret other people’s actions,
and poor imitative functioning may thus impact social pro-
cesses, though further work is needed (Cattaneo et al., 2007;
Fabbri-Destro et al., 2019). We did not find any significant
correlations in the DCD group, indicating that only in the
ASD group are imitation difficulties linked to socio-emo-
tional skills. In the DCD group, and not in the ASD group,
we have previously shown that praxis skills are significantly
related to motor ability rather than socio-emotional skills
(Kilroy et al., 2022).
Unexpectedly, in the ASD group, we found that
fewer errors (better performance) in pantomime imita-
tion timing, overall symbolic imitation performance,
and gesture-to-command body-part-for-tool errors were
related to increased restricted and repetitive behaviors.
These findings contradict findings that poorer motor
skills were related to increased restricted and repeti-
tive behaviors and attention in ASD (Bhat et al., 2022;
Ravizza et al., 2013), though to our knowledge this is
the first time a relationship with praxis skills has been
shown. Our findings may be due to a mediating factor
not analyzed here and needs further exploration in future
studies.
Finally, we note that while some investigators have
found correlations between praxis skills and autism
severity (Fabbri-Destro et  al., 2019; Gizzonio et  al.,
2015; Ingersoll & Meyer, 2011; Pittet et al., 2022; Rogers
et al., 2003; Zachor et al., 2010), contrary to our predic-
tions, we did not find any relationship between temporal
errors during imitation, or BPT errors during GTC, with
autism severity nor with other behavioral measures we
examined (verbal IQ, theory-of-mind abilities, empathic
processing, or ADHD symptomatology). We note that
nearly all the prior studies (except for Gizzonio et al.,
2015 and Fabbri-Destro et al., 2019) were conducted in
toddlers and/or children younger than 5 years old, and
the study by Fabbri-Destro et al. (2019) focused on spa-
tial errors during GTC, which may explain discrepan-
cies with the current study. Nevertheless, the finding
that both socio-emotional processing and restricted and
repetitive behaviors—two of the diagnostic criteria of
ASD—correlate with imitation and/or GTC errors, sug-
gests that a subset of prominent autism-related behaviors
are associated with imitation and praxis difficulties, and
may help better understand how motor and social deficits
could stem from similar underlying biological processes
in ASD.
Limitations
We note that the FAB-M is not norm-referenced, with
limited reporting of its psychometric properties, though
some of the concern was mitigated in the current study
by having at least two raters obtain scoring agreement.
Further, unlike the ADOS and Affect recognition and
ToM assessments, some of the other measures used here
(IRI, ADHD, and RRB) were self-report or parent-report
measures. Future studies using behavioral or observa-
tional measures of empathy, ADHD, and restricted and
repetitive behaviors would increase the validity of the
current results on those measures. Finally, we note that
our experimenters were not blind to the group of the par-
ticipants, which may bias results.
Conclusions
Here we show that timing errors during imitation of panto-
mimed actions and BPT errors during gesture-to-command
are significantly more common in the ASD group compared
to the DCD and TD group, and that these errors correlate
with socio-emotional skills and restricted and repetitive
behaviors. Indeed, it is noteworthy that unlike the DCD
group, in ASD, praxis skills are not correlated with motor
impairment but instead are correlated with core autism
symptomatology. Thus, in ASD, deficits in praxis skill may
be related to underlying etiology. This data may support the
notion that having intact processing of imitative temporal
sequencing may be critical for socio-emotional understand-
ing of others, though further work is needed. By contrast, in
DCD, underlying motor and praxis impairments are corre-
lated, but not related to social symptomology. Further stud-
ies are needed to investigate whether social disturbances in
DCD are primary or secondary symptomology (Tal Saban
& Kirby, 2019). Finally, these data suggest the need for
individualized ASD interventions, focusing on timing dur-
ing pantomime gesture imitation, and BPT errors during
gesture-to-command.
Acknowledgments  We thank all our participants and their families. We
also thank all lab members and research assistants for their contribu-
tions to participant recruitment, data collection, and scoring, in particu-
lar Riley McGuire and Trinh Nguyen. We also give special thanks to
Stewart Mostofsky and his team for training in scoring the FAB-M and
Dr. Mary Margaret Windsor for her assistance and careful considera-
tion of the FAB-M scoring and discussion. Research reported in this
publication was supported by the Eunice Kennedy Shriver National
Institute of Child Health and Human Development of the National
Institutes of Health under Award Number R01HD079432. The content
is solely the responsibility of the authors and does not necessarily rep-
resent the official views of the National Institutes of Health.
Author Contributions  LAZ and SAC performed the conceptualization.
LAZ, SAC, EK, CB, and LH performed the design. GA, AJ, EK, CB,
13
 Journal of Autism and Developmental Disorders

LH, PR, AH, and AN performed the data collection. GA and AJ per- Carpenter, M., Pennington, B. F., & Rogers, S. J. (2002). Interrela-
formed the data analysis. GA, AJ, LAZ, and SAC performed the data tions among social-cognitive skills in young children with autism.
interpretation. GA, AJ, and LAZ prepared the manuscript initial draft. Journal of Autism and Developmental Disorders, 32(2), 91–106.
GA, AJ, LAZ, SAC, EK, CB, LH, PR, AH, and AN performed the https://​doi.​org/​10.​1023/a:​10148​36521​114
manuscript editing. GA and AJ performed the figure creation. Cattaneo, L., Fabbri-Destro, M., Boria, S., Pieraccini, C., Monti, A.,
Cossu, G., & Rizzolatti, G. (2007). Impairment of actions chains
Funding  Funding was provided by Eunice Kennedy Shriver National in autism and its possible role in intention understanding. Pro-
Institute of Child Health and Human Development (Grant no. ceedings of the National Academy of Sciences, 104(45), 17825–
R01HD079432). 17830. https://​doi.​org/​10.​1073/​pnas.​07062​73104
Chang, S. H., & Yu, N. Y. (2016). Comparison of motor praxis and per-
Declarations  formance in children with varying levels of developmental coordi-
nation disorder. Human Movement Science, 48, 7–14. https://​doi.​
Conflict of interest  The authors state no conflicts of interest. org/​10.​1016/j.​humov.​2016.​04.​001
Chukoskie, L., Townsend, J., & Westerfield, M. (2013). Motor skill
in autism spectrum disorders: A subcortical view. International
Review of Neurobiology, 113, 207–249. https://​doi.​org/​10.​1016/​
B978-0-​12-​418700-​9.​00007-1
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