Physical Therapy Guide to Autism Spectrum Disorder
Children with autism spectrum disorder (ASD) have delays in the development of basic skills. These delays occur in specific areas. They may struggle to talk to and connect with others. They also may have limited and repeated behavior patterns. Often, there is a delay in forming motor (movement) skills.
Coordination and posture control are areas where children with ASD may struggle. Copying the actions of others is also hard for them. Symptoms of ASD vary from mild to severe. ASD occurs in about 1 in every 59 births in the United States. It is about 4 times more likely to occur in boys than girls.
Physical therapists (PTs) are movement specialists. They are in a unique position to help children with ASD. PTs help children with ASD develop their gross motor skills and basic movement skills. These skills help children with ASD play games, sports, and take part in physical education with their peers. PT's help children with ASD gain their full potential.
What Is Autism Spectrum Disorder?
Autism spectrum disorder (ASD) is a developmental disability. It results in social, communication, and behavior challenges. Signs of ASD begin in late infancy or early childhood. Sometimes it takes until the child is older to spot them. The signs of ASD continue throughout the life span. Before 2013, many terms described autism disorders. In 2013, the American Psychiatric Association merged all autism disorders into 1 umbrella diagnosis of ASD. They published the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DSM-5 is used to assign diagnoses, including ASD. The term "spectrum" allows for variations in the symptoms and behaviors found among children with ASD.
All the causes of ASD are not yet known. Environmental, genetic, and biological factors may make a person more likely to develop ASD. The number of children diagnosed with ASD is growing. This rise in cases may be related to better efforts to diagnose it. It may also be due to an increase in the causes of ASD that are not yet understood.
People with ASD have impaired motor (movement) skills. Research shows that those with ASD have limited coordination and postural control. They also have difficulty learning skills through imitation. Planning and completing certain movement skills are difficult for many children with ASD. These delays may make it hard for them to form social skills. As a result, they often do not participate with peers.
Research also shows that intervention programs, including physical therapy, can help children with ASD. These programs help them learn skills and improve their development. Early diagnosis can help them reach their full potential. Physical therapists are members of teams that provide services to children with ASD and their families. They work with people from early childhood through the school years and into adulthood.
Signs and Symptoms
The signs and symptoms of autism spectrum disorder (ASD) vary widely. ASD is a "spectrum" disorder because the symptoms displayed vary. People with mild symptoms are at one end of the spectrum. Those with more severe symptoms are at the other end.
Symptoms begin in early childhood and last throughout a lifetime. With intervention, symptoms can improve over time. Some parents notice symptoms of ASD before their child’s first birthday. By age 2, between 80% to 90% of parents see symptoms that interfere with their child's functions.
The 2 core signs that indicate a person may have ASD are:
- Challenges in social communication and interaction
- A tendency to restrict and repeat patterns of behavior
Signs and symptoms related to social communication and interaction may include:
- Avoids eye contact
- Prefers playing alone and not engaging in creative play
- Little interest in peers
- Lacks engagement in social interactions
- Shuns or resists physical contact
- Trouble understanding other people’s feelings, body language, and tone of voice
- Poor sense of personal space boundaries
- Delayed speech and language skills
- Lack of pointing or responding to pointing
- Repeats speech on a preferred topic or repetition of words or phrases
Signs and symptoms related to restricted, repetitive patterns of behavior may include:
- Self-stimulation through repeated activities (flaps hands/arms, spins, rocks)
- Becomes upset by minor changes, or needs to keep routines
- Obsessive interests, such as lines up toys or other objects
- Short attention span, except for preferred topics or activities
- Aggression, self-injury, or temper tantrums
- Lacks safety awareness
- Unusual reactions to sound, smell, taste, sight, touch, or movement
Other traits of ASD related to movement include:
- Delays in walking, jumping, skipping (large movement skills)
- Lags behind using the hands for things like buttoning a shirt or drawing (small movement skills)
- Trouble copying movements of other people (such as performing actions to songs with peers or jumping over a small object)
- Lacks coordination
- Poor balance
- Problems with planning and repeating movements
- Difficulty doing movements in a specific order
- Unstable walking
- Difficulty controlling posture
- Decreased eye-hand coordination
- Issues using sensory information for movement (This problem may range from a low-energy level—slow motor responses—to exaggerated responses. Craving movement is also possible.)
- Toe walking
How Is It Diagnosed?
If you think your child may have ASD, contact a physician. A correct diagnosis is the first step toward getting the help your child needs. The doctor may refer your child to a specialist for an in-depth evaluation and diagnosis. Specialists who diagnose ASD (or determine ASD is not present) include:
- Developmental pediatricians
- Child neurologists
- Child psychologists
- Child psychiatrists
The autism diagnostic and treatment team may consist of:
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Developmental pediatricians
There is no specific test to diagnose ASD. Health care providers may use assessment tools to aid their diagnosis. These may include the following:
- Autism Diagnostic Observation Schedule
- Second edition (ADOS-2)
- Autism Diagnostic Interview-Revised (ADI-R)
For an ASD diagnosis, a child's behavior and development must meet specific criteria. People diagnosed with ASD have symptoms that make it difficult to function. These symptoms are present from early childhood. Symptoms can go unnoticed until the child is older when social demands increase. Parents may recall symptoms they didn’t understand as ASD at that time.
How Can a Physical Therapist Help?
PTs have unique training in child development and motor control. This expertise allows them to assess a child's motor delays and functional performance. PTs work with your child, your family, and your child’s school to help them:
- Engage and improve in daily routines at home and school
- Acquire new motor skills
- Develop better coordination and a more stable posture
- Improve play skills, such as throwing and catching a ball with another person
- Develop motor imitation skills (learn by copying others' actions)
- Increase fitness and stamina
A physical therapist will evaluate your child thoroughly. This typically includes taking a health and developmental history. It will also include an assessment of:
- Postural strength and control
- Functional mobility (eg, walking and running)
- Body and safety awareness
- Play skills
- Interests and motivators
- Ability to change between different activities
- How your child jumps, hops, pedals a tricycle or bicycle, and skips
- Daily routines in the home, community, and school
Your physical therapist will work with you to develop goals to help your child. These goals will help your child participate as fully as possible at home and school. Your PT will then develop a plan to meet your child's and your whole family's needs. No "standard" treatment exists for children with ASD. Each child's challenges and goals are different. Your PT will personalize a program to meet the strengths and needs of your child. They will work with you to monitor your child's progress. They will collect data to ensure their plan is helping your child. They will adjust the plan as your child makes progress.
Physical Therapy in the Early Years: Birth to Age 3
Early delays in your child's movement skills may predict ASD. When delays are noticed early, a diagnosis can be made earlier. Early diagnosis means getting your child the help they need sooner.
Physical therapists work with families and caregivers. Their goal is to increase a child's ability to engage in the daily routines that challenge them.
PTs work with your child to develop age-appropriate movement skills. They use free and structured play to teach your child and help them practice skills. Physical therapists work on increasing your child’s strength and coordination. Their treatment plan can include helping your child walk safely and efficiently or how to use stairs. Your child's PT may prioritize the development of imitation skills. They may work with your child to perform actions to songs like “Head, Shoulders, Knees, and Toes” and indoor and outdoor play skills. Physical therapists guide you and your child on adding structure, routines, and physical boundaries into daily life. This guidance is designed to promote positive behaviors and help your child play with peers.
Physical Therapy in the School Years (Including Preschool): Ages 3 to 18
Physical therapists work with parents and teachers. They increase awareness about children with ASD. They also help school staff understand your child's ability to function in school. PTs use the latest, most effective treatments to minimize your child's challenges. Your child's PT will work with you to help make the school experience a positive one. Physical therapists also recommend changes to fit your child, support learning, and teach movement skills. These may include:
- Using ball chairs to reduce "out-of-seat behaviors"
- Hula hoop, carpet square, or special seat to mark personal space
- Whole-class movement breaks
- Strategies to teach skills needed to play social games
PTs provide direct help when needed to improve a child's ability to handle challenges. They work with your child to deal with school bus steps, crowded hallways, the lunchroom, and playground. PTs work with school teams to promote skills like self-control, listening, and taking turns. They teach methods to your child to promote their ability to:
- Copy the movement activities of other children
- Develop concepts of direction, body and spatial awareness, and coordination
- Take part in physical education and fitness activities
Physical Therapy During Adulthood: Age 18+
Physical therapists work with adults with ASD to promote success in daily life. They recommend community resources to increase movement. PTs develop personalized exercise routines. These routines promote physical fitness, body coordination, and recreation skills. PTs help people improve movement, function, and fitness. These skills help adults with ASD get and hold a job. They help them function at home, enjoy activities, and have a healthy lifestyle.
What Kind of Physical Therapist Do I Need?
All physical therapists have education and experience to treat people with autism spectrum disorder (ASD). However, you may want to consider:
- A physical therapist with experience in treating people with ASD. Some PTs focus on pediatrics (treating children).
- A physical therapist who is a board-certified specialist in pediatrics or who completed a residency in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to ASD.
Use Find a PT, a tool provided by the American Physical Therapy Association, to search for physical therapists by their location and experience.
General tips when you are looking for a physical therapist (or other health care provider):
- Ask family, friends, and other health care providers to recommend a PT.
- Ask about the PT's experience working with children with ASD before you make an appointment.
- Be prepared to describe your child's and family's needs in as much detail as possible on your first visit.
The American Physical Therapy Association (APTA) believes that consumers should have access to information to help them make health care decisions and prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of individuals with autism spectrum disorder (ASD). The articles report recent research and give an overview of the standards of practice in the United States and around the world. The article titles are linked to a PubMed* abstract of the article or to free full text. You may want to bring a copy of an article with you to your health care provider.
National Autism Center. National standards project: findings and conclusions/addressing the needs for evidence-based practice guidelines for autism spectrum disorders. National Autism Center website. Accessed November 8, 2019.
Hedgecock J, Dannemiller L, Shui A, Rapport M, Katz T. Associations of gross motor delay, behavior, and quality of life in young children with autism spectrum disorder. Phys Ther. 2018;98:251–259. Free Article.
Colebourn J, Golub-Victor A, Paez A. Developing overhand throwing skills for a child with autism with a collaborative approach in school-based therapy. Pediatr Phys Ther. 2017;29:262–269. Article Summary in PubMed.
Srinivasan SM, Pescatello LS, Bhat AN. Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Phys Ther. 2014;94(6):875–889. Article Summary in PubMed.
Downey R, Rapport MJ. Motor activity in children with autism: a review of current literature. Pediatr Phys Ther. 2012;24(1):2–20. Article Summary in PubMed.
Sowa M, Meulenbroek R. Effects of physical exercise on autism spectrum disorders: a meta-analysis. Res Autism Spectr Disord. 2012;6:46–57. Free Abstract here.
Fragala-Pinkham MA, Haley SM, O'Neil ME. Group swimming and aquatic exercise programme for children with autism spectrum disorders: a pilot study. Dev Neurorehabil. 2011;14(4):230–241. Article Summary in PubMed.
Anderson-Hanley C, Tureck K, Schneiderman RL. Autism and exergaming: effects on repetitive behaviors and cognition. Psychol Res Behav Manag. 2011;4:129–137. Free Article.
Bhat AN, Landa RJ, Galloway JC. Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. Phys Ther. 2011;91(7):1116–1129. Article Summary in PubMed.
Nobile M, Perego P, Piccinini L, et al. Further evidence of complex motor dysfunction in drug naive children with autism using automatic motion analysis of gait. Autism. 2011;15(3):263–283. Article Summary in PubMed.
Rinehart N, McGinley J. Is motor dysfunction core to autism spectrum disorder? Dev Med Child Neurol. 2010;52(8):697. Free Article.
Dziuk M, Gidley Larson JC, Apostu A, Mahone EM, Denckla MB, Mostofsky SH. Dyspraxia in autism: association with motor, social, and communicative deficits. Dev Med Child Neurol. 2007;49(10):734–739. Free Article.
Holloway J, Long T, Biasini F. Relationships between gross motor skills and social function in young boys with autism spectrum disorder. Pediatr Phys Ther. 2018;30:184-190. Free Article.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Revised by Jennifer Stephens, PT, DPT, board-certified specialist in pediatric physical therapy, and reviewed by Heidi Nelson, PT, DPT, board-certified specialist in pediatric physical therapy, on behalf of APTA’s Academy of Pediatric Physical Therapy (2019). Authored by Lori Glumac, PT, DSc, board-certified specialist in pediatric physical therapy; Bala Pallai, PT, DPT, MA, board-certified specialist in pediatric physical therapy; Karen Tartick, PT; Liliane Savard, PT, DPT, board-certified specialist in pediatric physical therapy; Marycarol Baker, PT; Karen Greeley, PT, DScPT; and Lisa Milkavich, PT, DPT (2014).