Autism Spectrum Disorders (ASD) is a diagnosis that describes kids with significant social, communicative, and behavioral challenges. While the diagnosis is mostly associated with difficulty with communication, there are also common physical issues experienced by children with ASD.
Some children with autism are not diagnosed until they are older, though retrospective studies have shown gross motor discrepancies in babies and toddlers who were later diagnosed to be on the spectrum. With so much treatment emphasis placed on their social and language impairments, physical limitations only become more amplified in these children as they age. Children with ASD can have trouble with a number of large postural tasks, such as sitting, walking, running, jumping, and balance. Studies have shown the prevalence of low muscle tone (hypotonia), toe-walking, ankle stiffness, motor apraxia, and increased motor stereotypes in children with autism. Hypotonia is the most common motor symptom, affecting up to 51% of these children.
How can physical therapists help children on the autism spectrum?
- Collaboration: Having a child on the autism spectrum (click here to view our autism infographic) can be challenging for parents. Limited social, behavioral, speech, and motor skills can lead to difficulties both at home and at school. With balance, coordination, and poor motor control at play, it is important for physical therapists to collaborate with other professionals involved in a child’s care. It is also important for physical therapists to contribute to the conversations involving parents and therapists. Physical therapists can address a child’s balance and postural control to encourage improved endurance and attention with school time activities. Knowing a child’s sensory processing needs and behavioral tendencies helps physical therapists make effective goals to make the most gains for a child with ASD associated gross motor delay.
- Education/Resources: Parents may not understand the link between physical performance and behavioral responses. A child with gait changes due to sensory-seeking behaviors or a child with poor balance due to decreased motor control will have a hard time participating in play and social skills. As some children are diagnosed years after gait deviations or musculoskeletal compensations are in place, parents also rely on physical therapists to provide information and resources for their child’s orthopedic or developmental needs. Physical therapists can direct parents to orthotists, equipment, or community sports programs specialized for their child with ASD.
- Therapeutic Play/Socialization: A huge focus of therapeutic exercises for children with ASD is to encourage large quality movements and age-appropriate play. For example, a child who walks on his toes will need exercises to increase ankle mobility and calf flexibility. A child who has a hard time holding his trunk upright during school will need exercises for postural control. Some children may have a hard time coordinating their limbs to participate in age-appropriate skills, such as hopping on one foot or skipping. Physical therapists help these kids gain more confidence in the skills they need in the future to navigate different environments and perform challenging tasks in the community as adults. Pediatric physical therapists often design treatment sessions where movements that hinder social participation are reduced and movements that lead to independence are encouraged.
New research on toddlers and preschoolers with autism found that children with better motor skills are more proficient at socialization and communication than those who have physical deficits. In addition, autism spectrum disorder has a wide range of presentations and physical involvements, with impairments varying from mild to severe. Physical therapists are becoming much more involved in the lives of children with ASD, in order to help these kids improve their day to day functioning from early childhood well into adulthood.
Oregon State University. Autistic children with better motor skills more adept at socializing. Available at: http://oregonstate.edu/ua/ncs/archives/2013/sep/autistic-children-better-motor-skills-more-adept-socializing. Accessed on July 7th, 2014.
Bullen, D. More than just playtime. Advance: Physical Therapy and Rehab Medicine. Vol.24 No.21. Available at http://physical-therapy.advanceweb.com/Features/Articles/More-than-Just-Playtime.aspx. Accessed on July 7th, 2014.
Ming, Xue, Michael Brimacombe, and George C. Wagner. “Prevalence of motor impairment in autism spectrum disorders.” Brain and Development 29.9 (2007): 565-570.