An intervention plan for the treatment of Autism Spectrum Disorders requires a multidisciplinary team of professionals to create and tailor a plan to fit a child with ASD. This team approach typically includes speech and language therapy and occupational therapy.
Physical therapy is often a missing piece in a child with ASDs treatment intervention. I believe children are often are not referred to physical therapy because gross motor skills are not uncommonly their highest area of function. However, they cannot perform these skills on request or imitation. This affects their ability to play interactively with other children. Gross motor skills are critical on the “playing ground” of learning socially and interactively with other children. Physical therapy is an excellent option in addressing the core deficits of autism.
These limitations can include:
Sensory processing: These challenges can cause a child to be overly or under sensitive to certain areas of the environment such as light, touch, noise, smell or movement. They may avoid or excessively seek out certain sensations.
Communication: Expressive and Receptive language limitations with both verbal and nonverbal behavior can be associated with a delay or total lack of spoken language, involving initiating or sustaining a conversation with others.
Social interaction: Deficits in nonverbal behavior such as eye to eye contact, referencing, learning imitation skills and turn taking.
Motor planning: Motor planning delays may limit a child’s ability to conceive of movements, retrieve the correct plans for that movement from the brain, perform that movement especially in interaction with others, correct errors in that movement, and remember what worked in the plan so the movement could be more accurately and efficiently performed in the future.
Decreased muscle tone: Decreased or low muscle tone causes poor body mechanics. Low tone or muscle stiffness requires a child to expend more energy to perform movements. This can result in lack of coordination, clumsiness, gross motor skill delays, poor posture, poor walking mechanics, etc.
Physical Therapy Evaluations
When I perform a physical therapy evaluation with an individual on the spectrum, I usually perform a standardized gross motor skills assessment. I pay particular attention to the following:
- How much sensory preparation/heavy work/aerobic activity is required to organize my client to get them to an optimal state for concentrated work? How often do I need to return to sensory work to keep them organized? Do I need to embed the activity itself with sensory input to keep them focused?
- What types of sensory input calms or organizes them and what types of sensory input excites or disorganizes them? Which type do I need to perform more? Are they under aroused or over aroused?
- How hard I have to work to gain the child’s attention to give them a meaningful demonstration?
- Do they know to look at the most relevant detail of the demonstration? For example, if I am walking on my tiptoes, do they look at my feet?
- Can they perform an activity on request? What level of complexity of an activity can they perform? Bilateral only or unilateral? Symmetrical only or asymmetrical as well? Upper body only or lower body as well? Do the upper and lower body movements need to mirror each other? How many steps in a sequence can they copy?
- Do they understand movement in relationship to themselves, another person, or things in their environment? For example, can they stand behind a line, behind a person, raise their right hand, or lay on their belly?
- What support do they need to imitate an activity? Do they need to be physically taken through the activity first? And then support faded? Do they need an immediate model? Can they copy an activity with a previous model? Do they perform better if a familiar caregiver or parent performs the activity first?
- Do they reference me or their caregiver to check in and see if they are doing an activity correctly?
- Do they understand implied cues (including gestural, facial, contextual, postural, tone/inflexion related) that a typical child would understand? If I say, “Stand over there (while pointing) and catch the ball.” Do they understand where to stand, what direction to face, and what basic body position to get into, i.e. they don’t face the wrong direction and don’t sit unless I am sitting.
- Do they have a history of interactional play with other children? If so, what types of play can they engage in? Parallel? Interactive? Pretend? Flexible? Rule bound games or sports?
If you want help with these suggestions or notice any of the above mentioned difficulties, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation.