A Physical Therapist’s Role in Treating Autism
Autism is classified as a developmental disorder that occurs on a spectrum. Each child will be affected differently and some cases will be more severe than others. However, in many cases, a child with ASD has some level of motor skill delay.
A PT's job is to treat a child with autism to improve their motor function, such as coordination and balance, and to advocate for those children. Many times, a child with ASD will have impairments that affect strength, endurance, muscle tone, coordination, and motor planning.1
Physical activity is a crucial part of a child’s life. This activity can be simple actions such as walking, skipping, jumping, or running, or can be more advanced movements like throwing, catching, or kicking. This movement takes place daily at home and school. Children use gym or recess times to get some physical activity in, reset their minds, calm down their bodies, and interact with other children. By helping to work on motor skills with children with ASD, a PT is helping a child to be able to participate more fully in all aspects of their lives.
A child with ASD will commonly struggle with social skills like reading social cues and interactions, or they may have no interest in others. They can have obsessive or repetitive patterns or lines of thinking and talking, especially when they find a topic of interest. These too can be addressed in physical therapy through motor, play-based therapy. In general, a child with ASD will often require multi-discipline therapy, requiring a therapist to be able to work with other therapists.
For physical therapists, treatment aimed at children with ASD will focus on improving large-movement skills such as balance, coordination, motor planning, posture, or toe walking. A child with autism may struggle with reciprocal play or imitation skills, all of which are fairly common in kid's activities such as gym class and all of which can be improved through physical therapy.
Obesity
In addition, research has shown that individuals on the autism spectrum are more prone to obesity, and this can start in early childhood. One study found that out of 5,053 children with autism, 33.6% of them were overweight and 18% of children between the ages of 2 and 17 were obese.2 The reason for this is complicated but can result from problem eating behaviors, less physical activity, and more medications with side effects of weight gain, and a genetic vulnerability.3
By recognizing that ASD youth are at risk for obesity, certain factors can be addressed from a young age. Teaching the motor skills required for physical activity can start at an early age, and thus exercise can become a part of a child’s routine.
A Positive Approach to Treatment
Lilliane Savard, a pediatric physical therapist, was interviewed in APTA’s article, “Physical Therapy for People with Autism,” and states that treatment to promote motor learning must include positive expectancy, autonomy support, and external focus attention.4 These tenets are applicable in therapy for all populations not just those children with autism.
A positive attitude is influential over anything, but garnering that positivity and setting up the conditions so that a child can achieve, such as celebrating little victories, helps to build up those good outcomes and a positive attitude. Supporting the child’s choice, or autonomy also gives a child the feeling that they have an option and control over the actions they are taking. Molding the treatment to follow the child’s lead will lead to a positive outcome. Finally, when working on a specific movement, like running, skipping, or throwing a ball, focusing attention away from the movement itself can help ease the pressure. Rather than putting pressure on the child, help them focus on other aspects of the movement, like where they want to jump instead of the movement their body needs to make for that to happen.
Motor Learning and Motor Play
Motor learning is acquiring a new skill through repetitive practice. To implement motor learning, it’s important to understand the environment, task, and individual.5 Each of these can be assessed and adapted to create success. It is also important to understand each of these and how a patient interacts with them to be able to approach motor learning in a way that will be most successful for that individual.
Each patient is different. In the case of autism, they may never have had the muscle strength or endurance to successfully jump rope or play hopscotch. Set up an environment that is helpful for this and entices the activity, such as using equipment like a trampoline. When focusing on the task, keep it simple and don’t over-cue. Let the child process and concentrate on completing the motor movement. Finally, understand the individual. Each child is different and even with a diagnosis of autism, the severity and effects are different in each case. Look at the whole child when treating. They may have been referred to physical therapy to improve muscle tone, but there can be other motor delays or deficits to be addressed. Set up treatment that helps build a good foundation for the future.
A great way to incorporate motor learning for children is through motor play, which is incorporating fun, creative movement to improve movement skills but also incorporates social and communication skills.6 This helps to incorporate the whole-child approach. This can be through activities like musical chairs, activity dice, or Simon Says.
Autism and Exercise
A great way to encourage physical activity is through programs designed specifically for those children with autism or other developmental delays. These groups not only work on promoting physical activity, but they can also improve social and communication skills. Different groups and camps geared towards those with developmental delays help because they will teach a child in a way they can understand.
Physical activity programs for children with autism have been shown to lead to Improved social and communication skills, muscular strength and endurance, Gross and fine motor skills, Hand-eye and eye-foot coordination, balance, and coordination.7 They are also a great way to continue applying techniques learned in therapy in everyday life and build a healthy foundation for the child’s future.
Therapist Resource
A great resource for PTs regarding current practices for treating a child with Autism is this fact sheet from APTA.
It lists a lot of different resources to stay up to date on how to approach treatment and how to educate parents.
In-Text Citations
1. Ries, Eric. “Physical Therapy for People With Autism,” APTA, 1 July 2018, https://www.apta.org/apta-magazine/2018/07/01/physical-therapy-for-people-with-autism.
2. Hill, Alison Presmanes, et al. “Obesity and Autism,” Pediatrics. 136, no. 6 (2015): 1051. doi:10.1542/peds.2015-1437
3. Hill, Alison Presmanes, et al. “Obesity and Autism,” 1052.
4. Ries, Eric, “Physical Therapy for People With Autism,” APTA.
5. Hayhurst, Chris. “Using Motor Learning To Help Patients” PT in Motion. 10, no. 1 (2018): 32. https://search-ebscohost-com.ezproxy.uakron.edu:2443/login.aspx?direct=true&db=s3h&AN=127519178&site=eds-live.
6. Ries, Eric, “Physical Therapy for People With Autism,” APTA.
7. Healy, Sean. “Autism and Exercise: Special Benefits, Autism Speaks, 5 September 2018, https://www.autismspeaks.org/expert-opinion/autism-exercise-benefits.
Full Sources
Glumac, Lori, et al. “Physical Therapy Guide to Autism Spectrum Disorder,” ChoosePT, revised 29 November 2021, https://www.choosept.com/guide/physical-therapy-guide-autism-spectrum-disorder.
Hayhurst, Chris. “Using Motor Learning To Help Patients” PT in Motion. 10, no. 1 (2018): 28–34. https://search-ebscohost-com.ezproxy.uakron.edu:2443/login.aspx?direct=true&db=s3h&AN=127519178&site=eds-live.
Healy, Sean. “Autism and Exercise: Special Benefits, Autism Speaks, 5 September 2018, https://www.autismspeaks.org/expert-opinion/autism-exercise-benefits.
Hill, Alison Presmanes, et al. “Obesity and Autism,” Pediatrics. 136, no. 6 (2015): 1051-61. doi:10.1542/peds.2015-1437
Ries, Eric. “Physical Therapy for People With Autism,” APTA, 1 July 2018, https://www.apta.org/apta-magazine/2018/07/01/physical-therapy-for-people-with-autism.