Physical Therapy Guide to Autism Spectrum Disorder
Autism spectrum disorder is a developmental disability. It affects how people experience the world. Children with ASD can have delays in the development of basic skills. These delays occur in specific areas. For example, some children with ASD can speak. Others may communicate in other ways or have trouble connecting with others. People with ASD also may restrict their behaviors or have repeated behavior patterns. Often, there is a delay in forming motor (movement) skills.
Coordination and posture control are areas where children with ASD may need help. Copying the actions of others may also be hard for some autistic people. Symptoms of ASD vary from mild to severe. ASD occurs in people of all racial, ethnic, and socioeconomic groups and affects all genders. Boys are about four times more likely to have ASD than girls. About one in 54 children in the United States have ASD.
Physical therapists are in a unique position to help children with ASD. They work with them to help them develop gross motor and basic movement skills. These skills help children play games and sports and take part in physical education with their peers.
Physical therapists support children and adolescents with special health care needs and disabilities by developing a plan to maximize abilities, prevent future injuries, and participate to the best of their abilities in all aspects of life. You can contact a physical therapist directly for an evaluation. To locate a physical therapist in your area, visit Find a PT.
Find a PT Near You!
What Is Autism Spectrum Disorder?
Autism spectrum disorder is a developmental disability. It results in social, communication, and behavior challenges that can range from mild to severe. 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 one umbrella diagnosis of ASD. They published the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Health care providers use DSM-5 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. Better efforts to diagnose ASD may relate to the increase in cases. It may also be due to an increase in the causes of ASD that are not yet understood.
People with ASD may have impaired motor (movement) skills. Research shows that those with ASD can have limited coordination and postural control. They also may have to work harder to learn 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 children with ASD 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 ASD vary widely. ASD is a "spectrum" disorder because the symptoms displayed can be mild to severe. 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 person's lifetime. With intervention, symptoms can improve over time. Some parents notice symptoms of ASD before their child's first birthday. By age two, between 80% to 90% of parents see symptoms that interfere with their child's functions.
The two core signs that indicate a person may have ASD are:
- Challenges in social communication and interaction.
- Tends to restrict and repeat patterns of behavior.
Signs and symptoms related to social communication and interaction may include:
- Avoiding eye contact.
- Preferring to play alone and not engage in creative play.
- Little interest in peers.
- Lack of engagement in social interactions.
- Shunning or resisting physical contact.
- Trouble understanding other people's feelings, body language, and tone of voice.
- A poor sense of personal space boundaries.
- Delayed speech and language skills.
- Lack of pointing or responding to pointing.
- Repeated 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 (flapping hands/arms, spinning, rocking).
- Being easily upset by minor changes or a need to keep routines.
- Obsessive interests, such as lining up toys or other objects.
- Short attention span, except for preferred topics or activities.
- Aggression, self-injury, or temper tantrums.
- Lack of safety awareness.
- Odd 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).
- Lagging behind using the hands for things like buttoning a shirt or drawing (small movement skills).
- Trouble copying other people's movements (such as performing actions to songs with peers or jumping over a small object).
- Lack of coordination.
- Poor balance.
- Problems planning and repeating movements.
- Trouble doing movements in a specific order.
- Unstable walking.
- Trouble controlling posture.
- Decreased eye-hand coordination.
- Issues using sensory information (such as touch, sound, and gravity) for movement. Problems may range from slow to exaggerated motor responses. A person with ASD may appear to have a low energy level or may crave movement.
- Toe walking.
How Is It Diagnosed?
If you think your child may have ASD, contact a doctor. 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:
- 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?
Physical therapists have unique training in child development and motor control. This expertise allows them to assess a child's motor delays and functional performance. Physical therapists work with your child, the family, and your child's school to help them:
- Engage and improve in daily routines at home and school.
- Acquire new movement 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 anothers' actions).
- Increase fitness and stamina.
A physical therapist will evaluate your child thoroughly. This will include taking a health and developmental history. Your child's physical therapist also will assess:
- Postural strength and control.
- Functional mobility (such as 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 participate as fully as possible at home and school. Your physical therapist will then create 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 physical therapist 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 also will collect data to ensure their plan is helping your child and 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. Reporting symptoms right away can enable early diagnosis so your child can get 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 may challenge them.
Physical therapists 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 physical therapist 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. They promote positive behaviors and help your child play with their 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. Physical therapists use the most effective treatments to minimize your child's challenges. Your child's physical therapist will work with you to help make the school experience a positive one. Physical therapists also recommend changes at home and school to help your child thrive, 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.
Physical therapists provide direct help when needed to improve a child's ability to handle challenges. For example, they work with your child to help them deal with school bus steps, crowded hallways, the lunchroom, and the playground. Physical therapists also work with school teams to promote skills like self-control, listening, and taking turns. They teach your child methods that 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. Physical therapists also design personalized exercise programs. These exercises will promote physical fitness, body coordination, and recreation skills. Physical therapists help adults improve movement, function, and fitness. These skills help people with ASD get and hold a job. They also help them function at home, enjoy activities, and keep a healthy lifestyle.
What Kind of Physical Therapist Do I Need?
All physical therapists have the education and experience to treat people with ASD. However, you may want to consider:
- A physical therapist with experience in treating people with ASD. Some physical therapists 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 believes that consumers should have access to information to help them make informed health care decisions and prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for autism spectrum disorder. They report recent research and give an overview of the standards of practice both in the United States and internationally. They link to a PubMed* abstract which may also offer free access to the full text, or to other resources. You can read them or print out a copy to bring 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 in 2019 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. Authored in 2014 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.