Screening autismu: IMES / Infant Motor and Engagement Scale

Infant Motor and Engagement Scale (IMES) 

Premises and Target Group

The Infant Motor and Engagement Scale (IMES) was developed to address the public health goal of early identification of Autism spectrum disorder (ASD). It is designed to assess the quality of infants' interaction with people and objects during early play, making it particularly relevant for infants as young as 6 months. The scale focuses on identifying early indicators of autism and motor impairments, allowing for timely interventions during a critical period of brain plasticity.

The persistence of primitive reflexes may alter the developmental trajectory of future motor ability, leading to motor impairments that are often unrecognized compared to the core signs of autism. However, early enabling intervention aimed at improving motor skills could have favorable effects on other domains of development.

Evaluation and Methodology

The IMES is a screening tool that consists of 12 activities assessing play, communication and imitation skills, and takes approximately 20 minutes to administer. The scale has shown preliminary psychometric properties and value in revealing infants at risk for autism. It has also demonstrated good interrater reliability and content validity through expert review, supporting its potential for early identification of at-risk infants.

The scale provides valuable insights into an infant's motor and cognitive development and can also indicate impairments related to the persistence of primary reflexes. The preliminary data support the validity and reliability of the IMES for early identification of infants at 6 to 9 months, with the potential to have a long-term impact on child and family outcomes.

Motor impairments are a typical early sign of Autism spectrum disorder (ASD), and the persistence of primitive reflexes may be a possible cause of these impairments. The IMES assessment can be performed by healthcare professionals, such as pediatricians, developmental specialists, and early intervention teams, who are well-equipped to administer and interpret the results of the IMES, allowing for early identification of infants at risk for motor impairments and autism. Early enabling intervention aimed at improving motor skills could have favorable effects on other domains of development.

• Reaching for and Grasping Objects: This activity assesses the infant's ability to coordinate hand movements and grasp objects, indicating fine motor skills development. Impairment in this activity may indicate issues with the development of the motor cortex and the cerebellum, which are responsible for coordinating and controlling voluntary movements. The persistence of the Symmetrical Tonic Neck Reflex (STNR) may interfere with the infant's ability to reach for and grasp objects, affecting their fine motor skills. The affected brain areas include the frontal and parietal lobes, which are associated with motor planning and execution.
• Transferring Objects from One Hand to the Other: This assesses the infant's hand-eye coordination and the ability to transfer and manipulate objects, reflecting the development of bilateral coordination. Impairment in this activity may indicate issues with the corpus callosum, which connects the brain's two hemispheres and is involved in coordinating motor movements between the two sides of the body. The persistence of primary reflexes can also affect vestibular and proprioceptive functioning, leading to difficulties in transferring objects between hands and coordinating movements.
• Rolling Over: This activity observes the infant's ability to perform a fundamental gross motor skill, indicating the development of strength and coordination in the upper and lower body. Impairment in this activity may indicate issues with the development of the motor cortex and the vestibular system, which are involved in controlling body movements and balance. The persistence of primary reflexes, such as the Asymmetrical Tonic Neck Reflex (ATNR), may hinder the infant's ability to roll over and develop fundamental gross motor skills. The affected brain areas include the parietal and occipital lobes, which are associated with sensory processing and visual-motor coordination.
• Crawling: This assesses the infant's ability to coordinate movements and develop strength in the arms and legs, reflecting the progression towards independent mobility. Impairment in this activity may indicate issues with the development of the motor cortex and the spinal cord, which are involved in controlling and coordinating muscle movements. The persistence of primary reflexes, such as the Spinal Galant reflex, may interfere with the infant's ability to coordinate crawling movements. The affected brain areas include the motor cortex and the spinal cord.
• Standing with Support: This activity observes the infant's ability to bear weight and maintain balance while standing with assistance, indicating the development of lower body strength and postural control. Impairment in this activity may indicate issues with the development of the cerebellum and the basal ganglia, which are involved in coordinating and controlling posture and balance. The persistence of primary reflexes can affect the infant's vestibular and proprioceptive functioning, leading to difficulties in maintaining balance while standing with support.
• Walking with Support: This assesses the infant's ability to take steps with assistance, reflecting the development of early walking skills and lower body coordination. Impairment in this activity may indicate issues with the development of the motor cortex and the cerebellum, which are involved in coordinating and controlling voluntary movements and balance. The persistence of primary reflexes can affect the infant's ability to coordinate walking movements and maintain balance while walking with support.
• Sitting without Support: This activity observes the infant's ability to maintain a seated position without assistance, indicating the development of core strength and postural control. Impairment in this activity may indicate issues with the development of the motor cortex and the spinal cord, which are involved in controlling and coordinating muscle movements and posture. The persistence of primary reflexes can interfere with the infant's ability to maintain a seated position without support.
• Playing with Toys: This assesses the infant's engagement in play activities, observing interactions with objects and the environment, reflecting cognitive and motor skill development. Impairment in this activity may indicate issues with the development of the motor cortex and the basal ganglia, which are involved in coordinating and controlling voluntary movements and motor planning. The persistence of primary reflexes can affect the infant's ability to manipulate and play with toys, impacting their fine motor skills and hand-eye coordination.
• Imitating Facial Expressions: This activity observes the infant's ability to mimic facial gestures, indicating social and emotional development and the coordination of facial muscles. Impairment in this activity may indicate issues with the development of the motor cortex and the limbic system, which are involved in controlling and coordinating facial expressions and emotional responses. The persistence of primary reflexes can interfere with the infant's ability to imitate facial expressions, affecting their social and emotional development.
• Imitating Hand Gestures: This assesses the infant's ability to replicate hand movements, reflecting the development of fine motor skills and hand-eye coordination. Impairment in this activity may indicate issues with the development of the motor cortex and the parietal lobe, which are involved in controlling and coordinating hand movements and spatial awareness. The persistence of primary reflexes can affect the infant's ability to imitate hand gestures, impacting their fine motor skills and hand-eye coordination.
• Responding to Name: This activity observes the infant's ability to recognize and respond to their name, reflecting social and cognitive development. Impairment in this activity may indicate issues with the development of the temporal lobe and the limbic system, which are involved in processing auditory information and social and emotional responses. The persistence of primary reflexes can interfere with the infant's ability to respond to their name, affecting their social and cognitive development.
• Engaging in Social Interaction: This assesses the infant's participation in social exchanges and interactions, reflecting the development of social communication and engagement skills. Impairment in this activity may indicate issues with the development of the prefrontal cortex and the limbic system, which are involved in controlling and coordinating social and emotional responses and behaviors. The persistence of primary reflexes can affect the infant's ability to engage in social interaction, impacting their social and emotional development.

Citations:
https://www.ncbi.nlm.nih.gov/books/NBK11940/
https://govinfo.library.unt.edu/negp/reports/prinrec.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216967/
https://www.frontiersin.org/articles/10.3389/fneur.2021.666980/full
https://pubmed.ncbi.nlm.nih.gov/36495161/