קשר עין-יד באוטיזם- Hand–Eye Coordination in Autism
- motim51
- Jan 2
- 6 min read
For most of us, the action of reaching for a glass of water or typing on a keyboard seems completely automatic.
But behind the scenes, the brain performs a complex coordination that integrates visual input with precise motor movement of the hand. This process is called hand–eye coordination.
Research from recent years sheds new light on how this process operates in children with typical development compared to autistic children.
It turns out that the differences are not found only in movement accuracy, but in the neural strategy that guides it.
Hand–eye coordination in children with typical development?
In children with typical development, the system operates according to a predictive (feedforward) model.
The eyes act as commanders: they land on the target about 50 to 200 milliseconds before the hand even begins to move.
This lead allows the brain to plan the hand movement in advance and execute it in a very smooth and highly synchronized manner.
Hand–eye coordination in autistic individuals?
Contrary to what one might assume, autistic individuals do not necessarily have a problem with eye movement speed.
A study from 2013 showed that in simple tasks, the gaze speed of autistic children was completely typical.
The challenge lies in the synchronization between the systems.
Key findings from recent studies (including a 2025 systematic review) point to several critical differences:
Absence of the “gap effect” in the hand
What exactly is the “gap effect”?
To understand the impairment, imagine that you are sitting in front of a screen.
At the center of the screen there is a red dot that you are looking at.
Suddenly, a blue target appears on the side of the screen.
Your task is simple: shift your gaze and point to the blue target as quickly as you can.
The researchers examined two conditions, as described in a 2013 study:
The overlap condition: the blue target appears on the side, but the red dot in the center remains on.
In this condition, the brain has to work harder to disengage from the central dot and move to the side.
The gap condition: the red dot in the center disappears, and only after a brief moment (the gap) does the blue target appear on the side.
What happens in most people? When the central dot disappears (the gap condition), the motor system receives something like a green light.
The brain understands that it is free from the previous target, and therefore both the eye and the hand respond much faster to the new target.
This is the “gap effect”, the boost in reaction speed when the path is cleared.
What was found in autistic children? This is where the fascinating finding emerges: in autistic children, the eyes actually responded faster in the gap condition (that is, eye movement was typical), but the hand did not receive the message.
Despite the fact that the stimulus at the center of the screen was cleared, the hand did not speed up its response as expected.
Why is this important? It shows that communication between the visual system (the eye) and the motor system (the hand) is impaired.
The information that the eye perceives (the center is clear, you can move!) is not translated into a rapid command to the hand.
In everyday life, this means that even if the child sees that something is happening, their physical response will be less synchronized and less efficient.
Planning ahead (Feedforward) versus correcting during movement (feedback)
Think about the difference between a skilled painter and someone trying to copy a drawing using transparent tracing paper.
The skilled painter (Feedforward): looks at the page, the brain builds a map of the line, and the hand simply moves forward confidently.
The eye is already at the next point before the pencil has even reached it.
The person tracing with transparent paper (feedback): he cannot rush ahead.
He has to look at the tip of the pencil every split second to make sure it is exactly on the line underneath.
He moves slowly and carefully, and his eyes are stuck on the hand instead of leading it.
In children with typical development, the brain works like the painter.
The eyes scan the target in advance and send the hand a ready-made action plan.
In autistic children, the brain has difficulty trusting the advance plan.
Instead, it works like the tracer: the eyes must accompany the hand step by step (feedback) to make sure it does not make a mistake.
Why is this exhausting? Because instead of the action being automatic and fluid, the child invests enormous concentration effort in every small movement.
This is why a simple action like writing a line in a notebook, putting on a coat, or eating with a fork can leave an autistic child exhausted, they have simply invested focused energy that most of us do not need to activate.
Increasing difficulty in complex tasks
As the task requires greater integration (such as catching a moving object or performing multi-step tasks), the gaps become more pronounced.
More substantial delays in reaction times and poorer coordination between the eye trajectory and the hand trajectory have been observed.
Effects on daily life
The challenges in hand–eye coordination in autistic individuals do not remain in the laboratory.
They significantly affect everyday functioning:
Learning skills: difficulties with writing, drawing, or copying from the board, which require rapid and synchronized shifting between gaze and movement.
Functional independence: actions such as writing, drawing, buttoning buttons, dressing, tying shoelaces, or using eating utensils become more complex and more tiring due to the need for constant visual monitoring of the hands.
Social interaction: a link has been found between the severity of motor impairments and he degree of social withdrawal, as ball games or shared activities require fast and accurate hand–eye coordination.
The challenge of nonverbal children
For a nonverbal child, pointing is not just a movement, it is their voice.
When an examiner asks, “Point to the hat,” they are testing the child on two levels at the same time:
Cognitive level: does the child recognize what a hat is?
Visual–motor level: is the brain able to synchronize the gaze on the hat with a command for the hand to move precisely toward it?
The diagnosis that may be mistaken: “He doesn’t understand”
As noted earlier, in autistic children there is sometimes a disruption in synchronization.
The child looks at the hat (it may be that they know the answer!), but because of the absence of the "gap effect" and the difficulty in movement prediction, their hand gets stuck or is sent in the wrong direction.
Here, a critical error may occur: the examiner or therapist sees that the child did not point, or pointed incorrectly, and may therefore draw a cognitive conclusion, “the child doesn’t know what a hat is,” “they are unable to understand instructions,” or “the child does not want to cooperate.” In reality, the barrier is motor–executive, not a lack of understanding or willingness.
The result may be the construction of a treatment program that does not match the child’s developmental age and cognitive abilities → leading to a cycle of intense frustration expressed in protest behaviors and emotional distress → parents experience despair and frustration and turn to professionals → professionals may make diagnoses that are not necessarily accurate → treatment programs stagnate → the child responds with further frustration, and the cycle begins again.
Of course, not every case originates from a hand–eye coordination difficulty, but it is a skill that should certainly be taken into account when a child fails to progress in a treatment program or shows significant clumsiness and genuine frustration with tasks that are relatively simple for their age.
Next week, we will take a deeper look at coping strategies and offer practical tips for practice in order to improve hand–eye coordination.
References:
Abid, M., Poitras, I., Gagnon, M., & Mercier, C. (2025). Eye-hand coordination during upper limb motor tasks in individuals with or without a neurodevelopmental disorder: a systematic review. Frontiers in Neurology, 16, 1569438. https://doi.org/10.3389/fneur.2025.1569438
Crippa, A., Forti, S., Perego, P., & Molteni, M. (2013). Eye-hand coordination in children with high functioning autism and Asperger’s disorder using a gap-overlap paradigm. Journal of autism and developmental disorders, 43(4), 841-850. DOI: 10.1007/s10803-012-1623-8
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