Autism Treatment Interventions

Overview

• The presentation focuses on treatment interventions for individuals with autism, presented by Kelly Burgio, PT, DPT.
• The objectives include identifying the prevalence of autism, understanding associated motor impairments, and describing the role of a school PT in treating children with autism and best practices for teaching motor skills.

Prevalence of Autism in the US

• As of 2023, the CDC reports that 1 in 36 individuals in the US are diagnosed with autism.
• The ratio of male to female diagnoses is 4:1.
• The prevalence in males is 1 in 34.
• The increase in prevalence is believed to be due to changes in diagnostic criteria and increased awareness.

General Features of Autism

• There are three core difficulties: social interaction, communication challenges, and repetitive behaviors.
• Kalin Bennett is noted as the first known athlete with autism to play basketball at a Division 1 school.

Motor Impairment in Autism

• Recent research is focusing on motor impairment in autism.
• Motor delays are often the first delays noticed in children who later develop ASD.
• Motor impairment prevalence is as high as 80% in individuals with autism.
• Motor impairment is not part of the diagnostic criteria for autism.
• Research supports that motor skills are impaired, but more research is needed to confirm if PT is effective at improving motor planning and skills in this population.

Specific Motor Impairments

• Poor automatization is a factor: over time, less attention needs to be required to perform novel motor tasks when learned.
• Poor balance and postural control are common.
• There is an ability to use sensory information, with good detection but difficulty interpreting and integrating it for motor planning.
• Stereotyped movements like arm flapping occur.
• There is poor imitation ability.
• A willingness to participate in non-preferred tasks limits repetition of activities; this affects motor learning.
• Muscle tightness and joint hypermobility are present.

Onset of Motor Delay

• Delays in motor control are often the first recognized signs in infants and young children later diagnosed with autism.
• At 1 month of age, babies in the NICU who later developed autism showed less extremity movement than other babies.
• Babies who later developed ASD were more sedentary and showed delays in crawling and walking.
• Persistent head lag at 6 months was noted with pull to sit.
• Parents often report that PT was the first early intervention referral.

PT in a School Setting for Students with ASD

• Focus is on the ability to access school through functional mobility.
• Functional mobility includes stairs/curbs/bus steps, body spatial awareness, floor transfers, carrying/holding objects, opening doors, and addressing gait issues.
• PT also aids in accessing the curriculum, including PE and recess.
• Goals are aligned to state standards, addressing coordination, manipulative skills, and balance.
• Balance reactions are also assessed, noting increased challenges with static vs. dynamic skills.

Age-Appropriate Gross Motor Skills

• Skills should be broken down into components.
• Tactile prompts are beneficial, as individuals are often very receptive to their own joint position but may need guidance, especially with imitation.
• Pairing tactile prompts with visuals and verbal cues, keeping the prompts simple and clear, can be effective.
• Goals should include fading prompts as comprehension increases.
• To improve compliance, strategies include visual schedules, frequent breaks, rewards, and mixing preferred objects or activities into the session.

Functional Mobility Intervention

• Incorporate videos to teach basic skills, using brief and consistent cues to break down the task.
• Hula hoops, spot markers, and carpet squares can improve body spatial awareness.
• Resources for a home stretching program for toe walking should include calf, hamstring, and hip muscles, and information about braces/casting/botox should be shared.
• Staff and family cuing should be consistent physically and verbally.

Manipulative Skills

• Avoid insisting on eye contact.
• Teach basics, as individuals may not understand body language related to catching or throwing.
• Anticipatory reactions are often lacking.
• Spot markers can help to identify where an individual needs to stay.
• Create cause/effect activities, such as knocking down pins with kicking or throwing.
• Take out the partner aspect initially.
• Start with rolling a ball back and forth while seated on the floor as it is predictable, reinforces partner play, and progresses to catching.

Lifelong Implications

• Motor deficits are not limited to the pediatric population with ASD.
• There is decreased overall physical activity, with a higher incidence of obesity and heart disease.
• There is also an increased incidence of parkinsonism in individuals with ASD.