Autism, NDIS and Paediatric Physiotherapy

Written By James Dowton

This is Part One on Our Autism Series, make sure to follow Adaptive Physiotherapy and Performance on Facebook and Instagram @adaptivephysioandperformance to learn more and stay up to date.

This article is designed to provide some clarity for parents, carers, therapists and those wanting to learn more about Autism to maximise children’s strengths and understand how Physiotherapy can play a key role in this process.

So first of all, what is Autism? Understanding Autism is key for management and identifying meaningful goals to work towards.

  • Autism Spectrum Disorder (ASD) is a neuro-developmental disorder characterised by impaired social interaction and communication abilities with many individuals presenting with developmental delay (delayed milestone achievement), reduced coordination, balance, reactions, strength and postural control.1-5 It is important to understand that Autism can present very differently for different people, and therefore it is essential that parents engage with therapists, specialists and supports that are able to assess your child's needs to collaboratively develop meaningful goals and provide therapeutic intervention.

Autism, Physiotherapy and Participation

  • Everyday movement (reaching, holding, walking, eating), activity (running, jumping, throwing) and play is a complex interplay of neurocognitive processes, sensory processes and reflexes. Autism (ASD) often impacts these areas resulting in motor difficulties which can lead to reduced participation with peers, reduced opportunities for social interaction, social development, motor development and skill acquisition6,7. Recent study has proposed that subtle motor control deficits limit normal cognitive and social development due to reduced opportunity to explore and interact with others and the  environment8.

  • Studies have demonstrated that children with ASD often experience issues with anxiety, this is compounded if children have challenges with balance skills as this has been linked to heightened levels of anxiety and stress9-12,  leading to activity avoidance and reduced opportunities to develop motor skills. Anxiety has been shown to alter sensory processing which can reduce social and communication skills limiting a child's ability to engage with peers13. Therefore, developing balance and gross motor skills presents an opportunity to enhance emotional regulation and increase engagement.

Children with ASD often have reduced physical activity levels and participate less than their age matched peers due to a variety of factors including:

  • Hypotonia (Low Muscle Tone): This can result in increased fatigue with physical activity, play and sport which can reduce willingness to engage in activity and limit opportunities for development, skill acquisition and developing gross motor strength, endurance and gross motor skills.

  • Motor Planning Issues (Planning, Sequencing and Dyspraxia): Motor planning is a skill that allows us to coordinate our body to complete physical activity, it is essential for completing movement, often issues with the “quality of movement”  or movement appearing “clumsy” can be a sign of issues with motor planning. Motor planning is essential for completing everyday tasks such as tying shoelaces, eating food, brushing teeth, putting on clothes and for sport, running, playing and participating in activities.

  • Reduced Balance and Postural Reactions: Balance control is a complex interaction between information processing, motor planning, timing and sequencing of movement6. Issues with balance and postural control/reactions limit a child’s sense of self, confidence and ability to participate in activity and sport.

So with all this in mind, how can Paediatric Physiotherapy assist?

Accurate assessment of your child is crucial in developing meaningful goals, identifying your child's strengths, barriers to participation and any motor deficits that may require therapeutic intervention. Identifying specific areas of delay will ensure your child receives the most appropriate intervention. These goals are integrated with other developmental goals (social interaction, speech, communication, education, sensory regulation) and therapy should work towards meeting these specific needs and goals of the child. 

Therapy should be fun and engaging, your Physiotherapist should work with your family to understand your child and develop a program that will engage your child and maximise their involvement. Sessions should be structured in a way that does not increase anxiety and provides opportunities for self-regulation. Physiotherapists are trained in the assessment of movement and movement disorders, this skill to assess means that we are able to utilise evidence based interventions and therapies to maximise your child's development. Paediatric Physiotherapy can involve

  • Exercises, activities and games that target specific muscle groups, control, motor endurance, balance, coordination and postural control.

  • Sensory feedback to enhance neuromuscular processing, body control and confidence.

  • Gross motor skill training, using techniques such as part practice to break down a movement into more achievable parts and then develop the movement as a whole.

  • Spatial awareness and orientation exercises

  • Using a variety of surroundings to develop social confidence and sensory regulation.

  • Activities that can enhance confidence, self esteem and joy of movement and activity.

Paediatric Physiotherapy services are available for NDIS, Medicare and Private Participants.

Paediatric Physiotherapy plays a key role in supporting children with Autism (ASD), if you have any questions or want to learn more; email: contact@adaptivephysioandperformance.com, call 0419964642 or visit: https://www.facebook.com/adaptivephysiotherapyandperformance


References:

  1. Fombonne E. Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord (2003) 33(4):365–82. doi:10.1023/ A:1024470920898

  2. Provost Lopez BR, Heimerl S. A Comparison of motor delays in young children: autism spectrum disorder, developmental delay, and developmental. J Autism Dev Disord (2007) 37(2):321–8. doi:10.1007/ s10803-006-0170-6 

  3. Bhat AN, Landa RJ, Cole-Galloway JC. Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. Phys Ther (2011) 91:1116–29. doi:10.2522/ptj.20100294 

  4. Fournier KA, Hass CJ, Naik SK, Lodha N, Cauraugh JH. Motor coordination in autism spectrum disorders: a synthesis and meta-analysis. J Autism Dev Disord (2010) 40(10):1227–40. doi:10.1007/s10803-010-0981-3 

  5. Rinehart NJ, Bradshaw JL, Brereton AV, Tonge BJ. Movement preparation in high-functioning autism and Asperger’s disorder: a serial choice reaction time task involving motor reprogramming. J Autism Dev Disord (2001) 31:79–88. doi:10.1023/A: 1005617831035

  6. John F. Stins, Claudia Emck. Balance Performance in Autism: A Brief Overview. Front Psychol. 2018; 9: 901. doi: 10.3389/fpsyg.2018.00901

  7. The relationship of motor skills and social communicative skills in school-aged children with autism spectrum disorder. MacDonald M, Lord C, Ulrich DA Adapt Phys Activ Q. 2013 Jul; 30(3):271-82.

  8. Differences in the use of vision and proprioception for postural control in autism spectrum disorder. Morris SL, Foster CJ, Parsons R, Falkmer M, Falkmer T, Rosalie SM Neuroscience. 2015 Oct 29; 307():273-80.

  9. Neurological bases for balance-anxiety links. Balaban CD, Thayer JF J Anxiety Disord. 2001 Jan-Apr; 15(1-2):53-79.

  10. Balance dysfunction in childhood anxiety: findings and theoretical approach. Erez O, Gordon CR, Sever J, Sadeh A, Mintz M. J Anxiety Disord. 2004; 18(3):341-56.

  11. Patterns of postural sway in high anxious children. Stins JF, Ledebt A, Emck C, van Dokkum EH, Beek PJ Behav Brain Funct. 2009 Oct 2; 5():42.

  12. Kim J. A., Szatmari P., Bryson S. E., Streiner D. L., Wilson F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism 4 117–132.

  13. Arousal, valence and their relative effects on postural control. Horslen BC, Carpenter MG Exp Brain Res. 2011 Nov; 215(1):27-34.

James Dowton