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. 2026 Feb 19;69(4):1643–1651. doi: 10.1044/2025_JSLHR-25-00841

Many Moving Parts: A Motor-Based Perspective on Developmental Speech and Language Research in Neurodevelopmental Disorders

Marc F Maffei a,✉, Jana M Iverson b
PMCID: PMC13086192  PMID: 41712880

Abstract

Research interest in the motor skills of children with neurodevelopmental disorders (NDDs) such as autism spectrum disorder and developmental language disorder is growing, for purposes including the prediction of language outcomes. Gross, fine, and oral motor skills are each associated with language development. However, research within these motor domains has largely proceeded along separate paths, with few studies examining how they codevelop and interact with language in children with NDDs. We propose that a unified developmental framework integrating these motor domains could enhance the prediction of language outcomes and the characterization of diverse clinical populations.

The development of motor skills in children has been referred to as “an open window on change” (Thelen, 2000). In contrast to language skills, the development of motor function is readily observable and quantifiable from birth. It is not surprising, then, that the development of human movement has long been a subject of scientific investigation. Over the past century, the acquisition of skills such as sitting, crawling, walking, and object manipulation have been thoroughly described, resulting in normative data that clinicians and researchers use to identify deviations from typical development. The development of oral motor skills (i.e., movements of the lips, tongue, jaw, soft palate, and lower face) has also been described. For instance, the age ranges in which children typically acquire speech sounds—thought to align with the increasing motor complexity of their underlying movements (Kent, 1984)—are well documented (see McLeod & Crowe, 2018). Research across motor domains has yielded invaluable assessment and intervention procedures and contributed to a deeper understanding of the physiological underpinnings of human behavior.

Despite this progress, research advances in the gross motor, fine motor, oral motor, and language domains have largely followed separate paths. Relatively few studies have examined how these systems interact and develop together, particularly in children with neurodevelopmental disorders (NDDs). However, available evidence suggests that gross motor, fine motor, and oral motor skills are each associated with language development. We propose that integrating these motor domains within a unified developmental framework, rather than examining them in isolation, will improve our ability to identify early predictors of language outcomes, characterize heterogeneity in clinical populations, and uncover mechanisms contributing to both typical and atypical development.

Motor Skills in NDDs

The past 2 decades have seen a surge of research interest in the motor skills of children with NDDs, including NDDs that are not typically associated with overt motor dysfunction, such as developmental language disorder (DLD; e.g., Zelaznik & Goffman, 2010), dyslexia (e.g., Chaix et al., 2007), and autism spectrum disorder (ASD; e.g., Fournier et al., 2010; Ming et al., 2007). The motivations behind these studies include the prediction of language outcomes (e.g., Sack et al., 2021) and the stratification of heterogeneous clinical populations (e.g., Provost et al., 2007). This focus on motor skills underscores a trend in developmental science toward ecological and dynamical systems frameworks, which emphasize how motor development can have cascading, cross-domain interactions with the environment and with structural, physiological, and cognitive processes (Adolph, 2019; Iverson, 2021; Thelen, 2002).

The advantages of studying motor development in NDDs are numerous (Esposito & Paşca, 2013). For instance, motor differences emerge early in populations such as ASD (e.g., Landa et al., 2012; Patterson et al., 2022; see Posar & Visconti, 2022, for a review), when the assessment of skills in other domains (e.g., social, linguistic, cognitive) can be impractical or insufficiently sensitive. Motor skills are also relatively straightforward to quantify, given the abundance of dedicated standardized motor assessments (e.g., the Peabody Developmental Motor Scales [Folio & Fewell, 2023] and the Movement Assessment Battery for Children [Henderson et al., 2007]), motor subscales of general developmental assessments (e.g., the Mullen Scales of Early Development [Mullen, 1995] and the Bayley Scales of Infant and Toddler Development [Bayley & Aylward, 2019]), behavioral coding schemes, and instrumental assessment technologies such as electromyography (Hautala et al., 2021), optical motion capture (Karch et al., 2012), and wearable sensors (Chen et al., 2016). Furthermore, the relatively low cognitive and linguistic demands of motor assessments make them broadly applicable across a range of ability levels.

Beyond these practical advantages, motor skills predict functional outcomes such as language skills. Specifically, significant longitudinal correlations have been reported between motor skills and language abilities. For example, not only do children with DLD (a diagnosis defined by language difficulties) demonstrate differences in fine and gross motor skills compared to children with typical language development (Sanjeevan & Mainela-Arnold, 2018; Zelaznik & Goffman, 2010), but motor skills related to balance and manual dexterity at age 4–5 years are correlated with language skills at age 6–7 years in that population (Sack et al., 2021). In children with an elevated likelihood of receiving an ASD diagnosis (i.e., younger siblings of autistic children), early motor skills are correlated not only with subsequent ASD diagnosis (Brian et al., 2008) but also with subsequent communication skills (Bhat et al., 2012; LeBarton & Iverson, 2013). In infants with an elevated likelihood of receiving a dyslexia diagnosis, slower motor development in the first year of life is associated with reduced vocabulary size and other language differences at ages 3 and 5 years (Viholainen et al., 2006). Such relationships exist in neurotypical development as well: The development of sitting skills is correlated with subsequent receptive vocabulary (Libertus & Violi, 2016) and expressive vocabulary (Oudgenoeg-Paz et al., 2012), and the emergence of walking skills is associated with communicative development (Oudgenoeg-Paz et al., 2016; Walle & Campos, 2014; West & Iverson, 2021)—although, interestingly, perhaps not among autistic children (West et al., 2024).

Oral Motor Skills in NDDs

Oral motor function is a relatively understudied aspect of motor development in NDDs despite the salient expressive language and feeding challenges associated with some of these conditions. For example, autistic children are five times more likely to experience feeding problems compared to their peers (Sharp et al., 2013), and many autistic children produce little or no spoken language (Tager-Flusberg & Kasari, 2013), yet relatively little research has attempted to characterize oral motor functioning in ASD (see Maffei et al., 2023, for a review). The small body of research that has been conducted on oral motor skills in ASD reveals increased speech sound errors (e.g., Broome et al., 2022), reduced intelligibility (Koegel et al., 1998), differences in speech consistency (Gladfelter & Goffman, 2018; Maffei et al., 2025), reduced speech rate (Chenausky et al., 2019; Patel et al., 2020), reduced vowel distinctiveness (Maffei et al., 2025), and other significant oral motor differences (Maffei et al., 2023). Oral motor differences have been identified in other NDDs as well, including populations without commonly reported or easily perceivable speech abnormalities. For instance, differences in the timing of articulatory movements have been reported in dyslexia (e.g., Duranovic & Sehic, 2013), and higher articulatory variability has been reported in DLD (e.g., DiDonato Brumbach & Goffman, 2014).

Measuring and analyzing oral motor function has at least two distinct advantages compared to the study of the gross and fine motor domains. First, a primary output of oral movements—speech—can be quantified using auditory–perceptual judgments (i.e., listening, particularly by a trained clinician or researcher) or acoustic (i.e., sound signal) analysis, two modalities unavailable to researchers measuring other human motor functions. In other words, speech is “movements made audible” (Stetson, 1928). Auditory–perceptual judgments are used to quantify prelinguistic vocalizations (e.g., Oller et al., 2021), children's speech in typical and atypical development (Kent et al., 2021; Schölderle et al., 2020), and adult speech across a range of clinical presentations (see Duffy, 2005). Perceptual judgments remain the gold standard in the clinical evaluation of oral motor function via standardized speech assessments (e.g., Goldman & Fristoe, 2015; Yorkston et al., 2007) and nonspeech oral mechanism examinations (e.g., St. Louis & Ruscello, 2000). However, despite their utility, auditory–perceptual judgments are associated with numerous sources of listener bias (Kent, 1996) and may not be sufficiently sensitive to subtle differences (Green, 2015).

Acoustic speech analysis, now widely conducted using accessible computer software (e.g., Praat; Boersma & Weenink, 2022), mitigates many of these limitations while also being inexpensive and noninvasive. Most importantly, acoustic speech data are associated with a variety of interpretable physiological features. For example, the resonant frequencies that characterize many speech sounds (i.e., formants) are associated with the shape and position of the tongue in the oral cavity (Lindblom & Sundberg, 1971). Thus, data regarding tongue movements—including their accuracy, speed, rate, range, and consistency—can be obtained without visual observation of the mouth or direct recordings of muscle activity, making them well suited for use with children. Other options for assessing oral motor function include parent report (e.g., Gernsbacher et al., 2008), surface electromyography recordings (see Gomes et al., 2009), kinematic analysis (e.g., Green et al., 2000; Nip et al., 2011; Wilson et al., 2012), and standardized feeding assessments (see Bickell et al., 2017).

A second key advantage of studying oral motor development, particularly in relation to language development, is its inherent connection to language: For most individuals, language is expressed through speech. Prior research has deepened our understanding of this relationship via studies of the neural mechanisms involved in programming and executing speech movements (Guenther, 2016), the co-emergence of speech motor control and language (Nip et al., 2011), and the theoretical nature of the speech-language relationship (e.g., Liberman & Whalen, 2000). Beyond speech production, the oral motor system also appears to be active during activities such as hearing speech (Watkins et al., 2003), writing words that were just heard (e.g., Locke & Fehr, 1972), and imagining a sound (Lima et al., 2016). While much of this work has focused on phonetic and phonological aspects of language (e.g., Goffman et al., 2007), emerging evidence suggests links between oral motor skills and higher order linguistic domains such as morphological, syntactic, and lexical abilities. For example, in neurotypically developing children, the ability to perform oral movements (e.g., licking the lips) is correlated with morphological development (Alcock, 2006), and the speed and range of oral movements are correlated with expressive vocabulary size (Nip et al., 2011). Among autistic children, nonspeech oral motor skills are associated with lexical and morphological development (Gernsbacher et al., 2008), and speech features such as consonant and vowel accuracy are correlated with lexical diversity (Maffei et al., 2024). Oral motor differences identified in children with DLD (e.g., Goffman, 1999), a population marked by early and persistent difficulties with grammatical morphology and other language skills, further suggest a link between oral motor and language skills.

An Integrated Approach

With few exceptions, research concerning associations between motor and language development in NDDs has excluded oral motor function; likewise, studies examining oral motor–language development tend to overlook gross and fine motor skills. This lack of cross-domain integration represents a missed opportunity in this growing area of clinical research. Specifically, we see the following six advantages to incorporating measures of gross, fine, and oral motor development in research on language in children with NDDs.

  1. Comparison of complementary data sources. Different motor domains offer unique and complementary insights into language development in NDDs. In a systematic review of motor–language cascades, Gonzalez et al. (2019) found that (a) both gross and fine motor skills show longitudinal associations with language outcomes, (b) these motor domains likely support language development via different means, and (c) further research is needed to compare motor domains on factors including the timeframes of motor–language cascades and the underlying mechanisms responsible for these relationships. Maffei et al. (2025) found that oral motor skills are correlated with language skills in autistic children, but that only a subset of those oral motor skills are correlated with fine motor skills, and very few are associated with gross motor skills. Performance across gross and fine motor tasks varies among autistic children, with some showing relative strengths in one domain over the other (Provost et al., 2007). Such findings suggest that different motor domains contribute to language in distinct, nonredundant ways.

    An ongoing discussion in developmental motor research centers around the appropriate level of analysis for interpreting these relationships. Gowen and Hamilton (2013) proposed that reframing how we conceptualize motor functions can sharpen distinctions between developmental disorders and clarify links between motor and other functional skills like language use. For example, conventional clinical categories such as gross and fine motor skills may obscure the motor control processes (e.g., sensory integration, state estimation, motor planning, motor execution) subserving different movement types. Incorporating a variety of motor assessments in a single study would allow researchers to identify within-subject commonalities in parameters such as speed, consistency, and precision across movement types—ultimately pointing to shared or divergent underlying processes that can be used to identify associations with speech and language development.

  2. Characterizing heterogeneity. NDDs, including ASD (Tager-Flusberg & Joseph, 2003), dyslexia (Zoubrinetzky et al., 2014), and DLD (Bishop, 2017), are marked by considerable heterogeneity in presentation, severity, and developmental trajectories. This variability not only presents substantial challenges for recruitment and participant selection (Tager-Flusberg, 2004) but is an obstacle to accurately characterizing a given population. To address this heterogeneity, researchers often report participant demographics and performance on standardized measures of cognitive and linguistic abilities. Yet, few studies consider the diversity of motor abilities in their samples, despite its potential to enrich our understanding of differences among members of these populations. Given the current lack of consensus around the prevalence, attributes, and severity of motor impairments in NDDs, measuring and reporting a range of motor abilities would also allow subsequent systematic reviews and meta-analyses to synthesize data and more accurately describe the breadth of motor profiles in these populations. Moreover, motor performance may help explain variability in core symptoms associated with NDDs, such as social-communication deficits in ASD (Leary & Hill, 1996). Importantly, motor ability may additionally influence other areas of functioning: Movement differences can impact children's performance on language or cognitive assessments, potentially confounding efforts to understand variability or detect group differences.

  3. Identifying subgroups based on differential motor profiles. Beyond quantifying the heterogeneity of motor skills within NDD populations, assessing a broad range of motor behaviors may reveal clinically meaningful subgroups. Belmonte et al. (2013) examined oral motor functioning in minimally speaking autistic children and found that it was not uniformly linked with gross and fine motor skills. They divided their sample into two subgroups: one with relatively intact gross and fine motor abilities but marked oral motor impairments and another with abilities distributed more evenly across subdomains. These subgroups differed in both baseline language levels and language learning rates during intervention (Belmonte et al., 2013). Hustad et al. (2016, 2020) have developed a speech-language profile group model to stratify children with cerebral palsy based on speech motor function and language/cognitive dimensions; the resulting subgroups demonstrate clinically relevant differences in speech intelligibility (Hustad et al., 2020) and cognitive skills (Jeong & Sim, 2023), highlighting the utility of multidimensional profiling for predicting functional abilities. The ability to identify valid subgroups using motor profiles has important implications for clinical practice, including enhancing diagnostic precision, improving prognostic models, and supporting the development of tailored interventions—ultimately contributing to more effective and equitable care in NDD populations.

  4. Identifying clusters of features associated with developmental outcomes. Advances in quantitative methods continue to enable more sophisticated analyses of complex, multidimensional data sets. Methods such as clustering, principal component analysis, and latent class modeling are well suited for capturing associations among diverse features like gross motor, fine motor, oral motor, and language measures. Such approaches have successfully identified meaningful subtypes and prognostic indicators in clinical populations. For instance, clinically relevant subtypes of Parkinson's disease have been identified using an analysis of motor and nonmotor symptoms (Mu et al., 2017), and clusters of perinatal factors and neuroimaging variables have been successfully used to predict later language function in children born preterm (Valavani et al., 2022). However, we are not aware of any work utilizing such techniques to identify clusters of motor skills associated with language development in NDDs. A cross-domain, data-driven approach has the potential to complement hypothesis-driven research on early identification, stratification, and intervention planning in NDDs.

  5. Understanding neurobiological mechanisms influencing development. Motor performance can offer a sensitive behavioral indicator of central nervous system function, providing a noninvasive window on the neural mechanisms underlying behavioral features in NDDs.

    There are well-established relationships between motor behaviors—including oral motor behaviors—and neurological structure and function. Speech production depends on the coordinated activity of numerous brain regions (see Guenther, 2016, for a review), and deviations in speech patterns reliably reflect abnormalities in particular brain structures or regions (Duffy, 2019). Differences in the rate and precision of speech in Parkinson's and Huntington's disease, for example, reflect basal ganglia dysfunction (Camerino et al., 2024), whereas specific difficulties with speech coordination can indicate cerebellar dysfunction in other populations (Ackermann et al., 2007). Neuroimaging studies have identified structural differences in motor- and cognition-related regions such as the thalamus, basal ganglia, cerebellum, and prefrontal cortex in NDD populations, including children with ASD (Hiremath et al., 2021) and DLD (Ullman et al., 2024). Such findings have motivated research into whether neurobiological differences underlie multiple behavioral signs (e.g., in motor and language skills) observed in particular NDDs. For instance, the Procedural Deficit Hypothesis (Ullman & Pierpont, 2005) proposes that a network of brain structures responsible for procedurally learned skills can largely explain both motor and language differences observed in DLD (Ullman & Pierpont, 2005) and perhaps other NDDs such as dyslexia (Nicolson et al., 2010). A related but more constrained hypothesis suggests that sequential dependency learning is central to both language-specific and domain-general deficits observed in DLD (Goffman & Gerken, 2023). By linking multiple behavioral differences to common underlying neurobiological and cognitive processes, such research highlights the potential for motor skills to serve as observable indicators of atypical neural development. Early motor assessments can therefore be a valuable and accessible tool for identifying children with NDDs at elevated likelihood for language impairments.

  6. Understanding the whole child. Researchers and clinicians often prioritize the most salient features of NDDs (e.g., language deficits in DLD and social communication challenges in ASD), and for good reason: These features directly affect developmental outcomes, academic success, and quality of life. However, a singular focus risks overlooking the broader impacts of these conditions. Because NDDs affect the developing nervous system, they rarely impact just one area of functioning but rather involve differences across multiple domains (e.g., motor, cognitive, linguistic, social), which must be considered in combination to fully understand the strengths and challenges of individual children. Interdisciplinary collaboration in research training (Gill et al., 2015), clinical training (Doherty et al., 2023), and clinical practice (Sylvester et al., 2017) is increasingly recognized as essential to this whole-child approach. These collaborations can bridge disciplinary silos, lead to more integrative research questions, allow for the interpretation of data through multiple lenses, and ultimately optimize outcomes. For instance, a study using videos of naturalistic play to examine the relationship between motor development and exploration could simultaneously inform questions about the development of fine motor skills (e.g., object manipulation), gross motor skills (e.g., type and frequency of locomotor behaviors), speech skills (e.g., acoustic variability), and language use (e.g., utterance complexity)—all without the need for separate investigations. This type of approach is not only more efficient but better reflects how children develop: not as sets of isolated behaviors, but as whole individuals.

Future Directions

Despite a growing research interest in the relationships among motor, speech, and language development in NDDs, many fundamental questions remain unanswered. Future research should aim to better characterize gross, fine, and oral motor development in these populations and, in particular, how these skills interact and relate to broader developmental outcomes like language ability. As discussed above, a holistic approach that integrates multiple motor domains offers a promising path forward. Such an approach would more clearly capture the complexity of neurodevelopment and provide meaningful insights into patterns characterizing particular populations as well as children's individual profiles.

A central gap in our understanding of the connection between motor and language development concerns whether oral motor development follows a trajectory similar to gross and fine motor development and whether these patterns are consistent across populations. Because oral motor skills are linked to both cognitive and linguistic processes (Nip et al., 2011), they likely hold a distinct status among motor skills, offering unique information about language development. Existing findings regarding similarities and differences in development across motor domains are mixed, and clarifying these relationships will inform differential diagnosis, help identify motor-based subgroups, and support targeted intervention strategies.

Another open question is whether incorporating multiple domains of motor function enhances the power of models predicting language outcomes. While most current research in this area relies on univariate predictors, including a broader range of theoretically grounded motor behaviors in predictive models would almost certainly offer a more comprehensive and accurate picture of language development in NDDs.

In conclusion, early motor behaviors hold significant promise as early indicators of language outcomes in NDDs due to the ease with which they can be observed from birth, the persistence of motor differences in NDDs, the large variety of established techniques for assessing motor function, and the growing body of research demonstrating significant longitudinal associations between motor and language skills. Integrating gross motor, fine motor, and oral motor skills into studies of language development will allow researchers and clinicians to characterize heterogeneity in NDDs (including the identification of clinically meaningful subgroups); identify clusters of motor behaviors associated with language outcomes; provide information about neurological underpinnings of behavioral differences; and promote a richer, more precise, and child-centered understanding of NDDs.

Data Availability Statement

Data sharing is not applicable as no new data were created or analyzed for this article.

Acknowledgments

This work was funded by the National Institutes of Health under Grants T32DC013017 (awarded to Maffei), F32DC022496 (awarded to Maffei), and R21HD111945 (awarded to Iverson).

Funding Statement

This work was funded by the National Institutes of Health under Grants T32DC013017 (awarded to Maffei), F32DC022496 (awarded to Maffei), and R21HD111945 (awarded to Iverson).

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