SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Autism
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1598182
This article is part of the Research TopicVery Early Identification and Intervention for Infants with Prodromes of AutismView all articles
Early Muscle Hypotonia as a Potential Marker for Autism Spectrum Disorder: a Systematic Review
Provisionally accepted
- 1Jiamusi University, Jiamusi, China
- 2Shenzhen Longgang District Maternal and Child Health Care Hospital, Shenzhen, China
- 3University of Göttingen, Göttingen, Lower Saxony, Germany
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Background: The diagnosis of ASD has increased globally owing to the expansion of diagnostic criteria, increased awareness, and improvement in symptom identification. However, the diagnosis of ASD in young or neurodivergent people remains challenging and requires the investigation of new early indications. Objectives: In this review, we examined the correlation between early hypotonia (including motor difficulties) and ASD, evaluating the potential of hypotonia as an early biomarker and screening instrument. Methods: Using the PRISMA criteria (PROSPERO: CRD42024626398), we searched PubMed, Embase, Cochrane Library, and Web of Science without any constraints on date or language. The inclusion criteria were derived from studies on children aged 0–6 years that investigated hypotonia (e.g., motor impairments or head lag) in connection with ASD diagnosis or characteristics. The eligible studies were prospective cohort, case-control, and retrospective video-analysis studies. Two researchers independently collected and evaluated the data. Results: Twenty-four studies (prospective cohort, case-control, or video analyses) were included in this review.The participants were aged 2 months to 6 years and included infant siblings of autistic children (a cohort with elevated likelihood of an autism diagnosis), children with familial ASD, and individuals from the general population.The research showed a consistent association of hypotonia and motor difficulties with ASD, despite variations in assessment methodologies, such as standardized motor measures and clinical evaluations. However, despite methodological heterogeneity, cumulative evidence supported the potential of hypotonia as an early ASD biomarker. Conclusion: Hypotonia and related motor differences may serve as practical screening indicators of increased likelihood of a later autism diagnosis. Identifying these signs can prompt earlier referral and support. While the findings are promising, further research is needed to standardize assessment protocols and validate clinical utility. Interdisciplinary collaboration may facilitate early detection, enhancing long-term outcomes through timely assistance.
Keywords: Autism Spectrum Disorder, hypotonia, Motor Skills, Child Development, Interfere
Received: 22 Mar 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Ting, Wang, Cao, Ma and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhihai Lu, Shenzhen Longgang District Maternal and Child Health Care Hospital, Shenzhen, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.