Physical Therapy and Children with Autism Spectrum Disorders

Early Childhood Movement and ASD

Movement is an integral part of our social, emotional, and physical lives. A 4-month old excitedly kicks her arms and legs in response to the funny face dad makes, so he does it again. An 8-month old will crawl to retrieve her favorite rattle, shake it to hear the sound it makes, and then look at mom to share the experience with her. An 18 month-old takes moms hand, walks her to the kitchen, and says “juice” while pointing to the refrigerator. As a child grows, the length and complexity of movement sequences become more sophisticated.

Children with Autism Spectrum Disorders often cannot coordinate the myriad of movements needed to complete these interactions. Although children with ASD are often not diagnosed until they are far out of infancy, studies of home videos of children later diagnosed with ASD showed motor differences that had been undetected as infants. These motor differences in children with ASD are often due to difficulties with motor planning, sensory processing and low tone.

Motor planning challenges make it difficult for a child to time, sequence, and execute a movement, such as reaching for an object, crawling towards mom, or activating a toy.

Sensory processing differences can alter a child’s life experience. The child may be over or under sensitive to smell, sight, sound, touch, or movement. They may also have difficulty tuning out sounds, smells, or sights in the background. They also may have difficulty looking and listening at the same time.

Low tone, or decreased stiffness of the muscles, requires the child to use more energy to move, can delay motor development, and further alters the sensory feedback a child receives during movement. Despite low tone and often accompanying excessive flexibility in some of the body, there is often tightness and asymmetries in the core, where the foundations of quality movement develop.

Children with ASD will learn to walk at an average age, but the quality of their movements are often poor. They often walk on their tiptoes or have problems paying attention to where they are walking. A majority of children later diagnosed with ASD skip the crawling stage. Crawling requires coordinating opposite sides of the body and good core control, that many children with ASD don’t develop on their own. As the child gets older, they may struggle to perform more advanced skills when they have not mastered these core foundations.

Children with ASD often have difficulty with balance, putting their hands out to catch themselves when they fall, and lack variety in their movement strategies. These differences may look like clumsiness, poor attention, hyperactivity, gross motor skill delay, flat feet, toe-walking, poor posture and frequent w-sitting.

Physical Therapy and ASD

Physical therapists can help children with ASD build up these movement foundations to have improved social and communication skills, in addition to their motor skills.

During a Physical Therapy Evaluation, a Physical Therapist will:

  • Look closely at the child’s ability to take in sensory input and control motor output
  • Assess the facilitating and limiting factors for different gross motor skills, such as walking, jumping, running, stair climbing and kicking a ball.
  • Observe, through play, how a child uses his balance reactions, protective reactions, and motor planning skills, and the strategies that the child uses to move in and out of different positions.
  • Observes the child’s posture in a variety of positions, and how the child’s posture affects their breath control, oral motor control and vocalizations.
  • Analyze which muscle groups are being overused and which muscle groups are being underused.

During Treatment, a Physical Therapist may work with a child with ASD to: 

  • Improve postural control to increase stability during fine motor, gross motor, and self-care activities.
  • Improve static balance to improve motor control and attention and decrease impulsivity.
  • Learn to perform the ideation, sequencing, timing and execution components of motor planning.
  • Maximize visual-vestibular motor integration for improved function in everyday life.
  • Lay down the foundations of gross motor skills to support participation in community and peer activities.

The SMILE Approach to Physical Therapy

Kid PT uses the Sensory Motor Integration for Life and Education (SMILE) approach to build up the core foundations of movement that many children with ASD have not developed on their own. The three pieces of SMILE work together to ALIGN the body, ACTIVATE the neuromuscular system, and INTEGRATE the sensory-motor systems. These three pillars work as a sequence of increasing sensory-motor complexity to build a solid foundation for movement.

A key component of the SMILE approach for kids with ASD is the Integration Level. Therapists at Kid PT frequently use visual-motor treadmill program to help children with autism spectrum disorders to achieve their goals. The program is a structured program that uses a picture schedule to organize the activities. It works to develop rhythmicity and automaticity in order to multi-task and to free the child up for higher cognitive and executive function skills. The program introduces visual demands combined with walking to facilitate fusion of the peripheral and central visual systems, which happens in typical development. The treadmill program can be done in clinic or at home. Goals achieved have included improved eye contact, social interactions, handwriting, balance, multi-tasking, and decreased toe-walking.

Children of all ages learn through movement and need to master core motor skills in order to maximize their overall potential. Physical Therapy and the SMILE Approach can be a beneficial part of a team approach to help children with ASD to be as successful and independent as possible in school, home and in the community.

If you have concerns both in your child’s movement patterns as well as their engagement with you, contact Kid PT here or Call us at 908-543-4390 to arrange a screening.