Abstract Background: Hand preference reflects the cerebral dominance associated with language, cognition, and manual skills development. Children with autism spectrum disorder (ASD) show less hand dominance as compared to typically developing children. This study aims to investigate the relationship between the development of hand preference and its association with developmental skills in children with ASD. Objective: The study aims to analyze the relationship between the emergence of hand preference and the primary developmental domains of children with ASD. Study Design: This was a cross-sectional study. Methods: A convenient sampling method was used for the sample selection. The study recruited children diagnosed with ASD between 3 and 6 years old. The study was conducted in a clinical setting at Dexterity Occupational Therapy Services, Bangalore. The children selected based on criteria were evaluated with the Indian Scale for Assessment of Autism (ISAA) for severity, the modified Edinburgh Handedness Inventory to assess hand preference, and the Developmental Assessment of Young Children-Second Edition (DAYC-2) to evaluate the primary developmental domains. Scores on DAYC-2 were correlated with the scores of the modified Edinburgh Handedness Inventory. Results: Fifty-four children were recruited, including 43 boys and 11 girls. The mean age of the children included in the study was 52.09 ± 9.08 months. ISAA scores revealed 25 children belong to mild, 26 belong to moderate, and 3 belong to the severe category of autism. The scores of the modified Edinburgh Handedness Inventory are significantly correlated with expressive (P = 0.029; 95% confidence interval [CI]: 0.029–0.521), receptive (P = 0.007; 95% CI: 0.100–0.571), socioemotional (P = 0.009; 95% CI: 0.088–0.563), adaptive behavior (P = 0.008; 95% CI: 0.094–0.567), and fine motor (P = 0.001; 95% CI: 0.174–0.620) domains of DAYC-2 with weightage to the age. Conclusion: This study concluded that the emergence of hand preference in ASD children had a clear association with the developmental domains of DAYC-2, which indicates that targeted intervention to strengthen hand preference may facilitate the child’s development.
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