Here at Milestone Pediatric Therapy we are celebrating National Autism Awareness Month. Dr. McIntyre wanted to highlight the new and evolving role of pediatric physical therapy in helping children with ASD improve not only their gross motor function but their social function as well! With more and more research out every day on the important link between motor development and social development, pediatric physical therapists like Dr. McIntyre take on a more important role in the therapeutic interventions for these wonderful and unique children.
What is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) lately has been in the news every where. You may think you have a good grasp on “what” ASD is but many people don’t understand/know all the pieces that actually go into an ASD diagnosis. Autism Speaks defines Autism as the following:
“…broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication”
The CDC estimates that likely 1/59 children in the US are affected by Autism or are on the Spectrum. Most children are diagnosed with Autism between the ages of 2-3 years old but can be diagnosed as early as 18 months if there are other developmental delays present. The most basic symptoms of ASD are
social, communication challenges AND
restrictive, repetitive behaviors
These behaviors begin in early childhood, persist, and interfere with daily living.
ASD often has associated medical issues with their GI tract, sleeping disorders, and other mental health conditions such as anxiety. ASD also deals with a variety of sensory sensitivities and coordination/movement disorders which may or may not be related to their sensory sensitivities.
All individuals with ASD present completely uniquely and there is no set rules to how each case will present. Early intervention through a variety of therapies has however been shown to help these children reach an more independent function in adulthood. Some children with ASD will always need some level of support with their daily activities but other children with ASD grow up to be fully functioning independent adults.
For more detailed information and checklists of behaviors visit Autism Speaks.
But if Autism is more of a social issue…why do they need physical therapy??
Recent research has begun to show differences in motor planning and sequencing in children with a diagnosis of ASD. Other research has been showing a gross motor and coordination delay in children with Autism as well. The newest research has shown as early as 9 weeks old children with eventual diagnosis of Autism demonstrated decreased midline head control.
Sensory sensitivities may also lead to other changes in motor development and movement strategies. Children with ASD are more likely to toe walk, avoid activities that may invoke gravitational insecurities, or only participate in singular activities that stimulate their sensory system in a way they like. This leaves them with uniform motor patterns and lack variety of exploration of movement to develop their vestibular system, balance system, strength, and other gross motor skills.
So why does this matter? So what if they have some motor delays… don’t they need more work on their social and behavioral skills? Well…An important study recently showed a large correlation between social skills and gross motor skills in children with ASD. Those with higher gross motor skills also had higher social skills. Those with poorer gross motor skills (specifically object manipulation skills) and poor core strength/stability demonstrated the most delays in social and behavioral skills. This has a large implication for physical therapy to address the impact of motor development, core strength, and ball skills in children with autism.
Benefits/Role of PT
While studies looking at the specific benefits on social skills and function from physical therapy intervention are still coming down the pipe line… there is plenty of anecdotal evidence and research to support physical therapists should begin to take on a greater role in the treatment approach for children with ASD. Working hand and hand with a child’s occupational, speech, and behavioral therapist, a physical therapist could incorporate other therapeutic goals into a session while working on strength to climb a playground and sharing a swing with another child.
Physical therapists are movement experts. As a pediatric PT, we aim to work on optimizing a child’s movement to promote play. And play is a highly social activity for most children. In order to engage in ball play you need to be able to make eye contact with your peer then catch the ball while having enough stability and balance to manipulate that same ball and throw it accurately back. There are huge motor planning, core strength, and balance implications at play here and PT’s work on all those things with children with ASD.
Potential Benefits from Pediatric PT for a child with ASD:
Increased arm, leg, and core strength
Improved balance and dynamic control of self through space
Improved stability
Improved ball skills and object manipulation skills
Improved coordination
Improved gait pattern (if the child is a toe walker or struggling with obtaining the ability to walk or run)
Improved gross motor skills
Support with gross motor exploration and exposure to new motor tasks
Improved participation in physical activity (keeping them healthy and preventing health decline as the child ages into adulthood)
A new study in 2018 looked at a 48wk exercise program that improved quality of life, metabolic measurements, and autistic traits in the experimental group of children ages 6-12 years with ASD. This study is supporting the role of the physical therapist in promoting physical activity (PA) participation and getting a child with autism involved in community level PA.
Treatment at Milestone
Here at Milestone, Dr. McIntyre recognizes how unique and individual each child with Autism presents. To quote Dr. Stephen Shore ~
“If you’ve met one person with autism, you’ve met one person with autism.”
Dr. McIntyre works to design a program just as unique as the individual when working with the family and child with Autism. She takes into consideration the family’s goals, the child’s specific behavioral traits, sensory sensitivities, and personal likes/dislikes when designing her physical therapy intervention program. She also works to incorporate a child’s other therapists into the plan of care. She reaches out to occupational, speech, and ABA therapists for their goals and therapeutic advice for working with each specific child. As with any client, a child with ASD benefits so much more from a continuum of medical care and coordination between providers. Early physical therapy intervention could dramatically improve your child’s ability to socially play and interact without the barrier of physical limitations.
As more and more research continues to show tie between gross motor/coordination development and social function, physical therapy will continue to take on a more and more important role in facilitating the activities of daily living, school access, and participation in peer to peer play in children with ASD. Hopefully with more referrals and access to pediatric physical therapy research on children with ASD will also begin to demonstrate where PT can be most effective in helping these children reach their goals and promote independent function in our world.
Resources
AutismSpeaks.org
Downey et al. Motor Activity in Children With Autism: A Review of Current Literature. Journal of Pediatric Physical Therapy. 2012
Gima et al. Early motor signs of autism spectrum disorder in spontaneous position and movement of the head. Experimental Brain Research. 2018.
Haylie et al. Children with Autism Spectrum Disorder, Developmental Coordination Disorder, and typical development differ in characteristics of dynamic postural control: A preliminary study. Gait and Posture. 2018.
Holloway et al. Relationships Between Gross Motor Skills and Social Function in Young Boys With Autism Spectrum Disorder. Journal of Pediatric Physical Therapy. 2018.
Lane et al. Motor Characteristics of Young Children Referred for Possible Autism Spectrum Disorder. Journal of Pediatric Physical Therapy. 2012
Rosales et al. sEMG Analysis During Landing in Children With Autism Spectrum Disorder: A Pilot Study. Journal of Pediatric Physical Therapy. 2018
Toscano et al. Exercise Effects for Children With Autism Spectrum Disorder: Metabolic Health, Autistic Traits, and Quality of Life. Percept Mot Skills. 2018 Feb;125(1):126-146. doi: 10.1177/0031512517743823. Epub 2017 Dec 9.