Autism Spectrum Disorder and Motor Development

 

Original Editor - Alan Jit Ho Mak

Top Contributors - Alan Jit Ho Mak, Niha Mulla, Ahmed M Diab, Aminat Abolade, Mahbubur Rahman, Aleena Shibli, Kim Jackson, Khloud Shreif, Ines Musabyemariya and Alexandra Stead  

What is Autism Spectrum Disorder?

Autism Spectrum Disorder (ASD) is a complex neurological and developmental disability that manifests in early childhood. Autism affects the normal functioning of the brain and can be characterised by varying degree of difficulty with social interaction and communication. Other characteristics are atypical patterns of activities and behaviors, such as difficulty with transition from one activity to another, a focus on details and unusual reactions to sensations.

The abilities and needs of autistic people vary and can evolve over time. While some people with autism can live independently, others have severe disabilities and require life-long care and support. Autism often has an impact on education and employment opportunities. In addition, the demands on families providing care and support can be significant. Societal attitudes and the level of support provided by local and national authorities are important factors determining the quality of life of people with autism.

Societal attitudes and the level of support provided by local and national authorities are important factors determining the quality of life of people with autism.at can present in varying degrees, influencing communication, social interactions, and behaviour patterns.

Autism has been regarded as a life-long condition and it cannot be cured. However, severity may decrease through special education and treatments. Males tend to have a higher prevalence than females.  

Study has found that ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. But the stability of diagnosis at age 9 years was very high for autism, at age 2 years and less strong for pervasive developmental disorder not otherwise specified.

Aetiology

To date, the cause of ASD is still unknown. Some argued it to be a result of, the abnormalities in the rate of early brain development. Happe and Ronald (2008) explained the most common contributory genetic, cognitive as well as neurodevelopmental factors that contribute to the characteristic triad of symptoms of ASD, for example, language delay, social impairment and repetitive behaviour.

Kinney et al. (2010) have explored nine environmental factors for which exposure before conception, appears to be associated with an increased risk for Autism. It is crucial to identify these factors which may include environmental change, and medical and physiotherapy interventions;  which may be conceivable to limit the activating vulnerability and consequently lessen the prevalence of the vulnerabilities and their association with ASD.  

Epidemiology

It is estimated that worldwide about 1 in 100 children has autism. This estimate represents an average figure, and reported prevalence varies substantially across studies. Some well-controlled studies have, however, reported figures that are substantially higher. The prevalence of autism in many low- and middle-income countries is unknown.

PREVALENCE:

There is no doubt that the prevalence of ASD around the globe among children is on the rise. Phetrasuwan, Miles and Mesiiboy (2009) indicated that in the United States, there were 0.4 or 0.5 children with ASD among 1,000 children before 1985 and recently this has been increased to 1 in 150 children. According to 2010 statistics from the Centres for Disease Control and Prevention, 1/100 children in the US are diagnosed with some form of Autism. 

Children with ASD diagnosis present some core deficits, the symptoms can be diverse, ranging from those severely affected by numerous attributes to fewer characteristics. However, Isaksen, Diseth, Schjølberg and Skjeldal (2013) argued that it may be unclear as to whether the increase in the prevalence of autism represents a genuine change in the commonality of the disorder or simply due to the methodological issues, broadening of diagnostic criteria, and increase public and professional familiarity with the conditions or better accessibility of services.

ASD with Motor Difficulties In Children

Children with ASD may appear awkward in their motor skills and movement. Many of these coordination problems when combined with communication, social skills and behavioural problems can lead to more complex learning difficulties in later development such as playground and sporting skills. 

Exercise-based physiotherapy treatments include age-appropriate physical and motor skills, like jumping, clapping hands, skipping, hopping and throwing, kicking or catching a ball. 

Sensory treatment for ASD children

Motor Control Difficulties in Children with ASD

There are some children without a clear neurological disorder present with poor motor abilities before 7 years of age. Some of these children could be considered to have 'Developmental Coordination Disorder (DCD) in DSM criteria. However, it appears that the majority of children with DCD are identified after starting school. In some cases, poor motor performance at preschool age is considered as one of the first clear signs of another comorbidity for developmental disorders such as ASD or Attention Deficit Hyperactivity Disorder (ADHD). Although motor disorders can occur on their own, it has been suggested that they frequently coexist with ADHD and ASD Motor control difficulties are very common in ASD children. DCD is found to present in about half of all individuals with ASD and ADHD. Recently, research has increased in the search for the links between DCD and ASD. 

A study by Kopp found that school girls with ASD and/or ADHD, with average or near average intellectual level, had more motor coordination problems than girls from the community population. 4 out of 5 preschool girls with ASD had motor coordination difficulties. Some differences in motor and sensory performance were found across the main diagnostic groups, with more gross motor and sensation impairments in the ASD group than the group with ADHD. Motor coordination problems were also associated with a decreased ability in daily living skills. These results confirmed that poor levels of adaptive daily skills are not only related to social, communicative and attention impairments but also to motor difficulties.    

Motor training with ASD children

Physiotherapy for Children with Autism Spectrum Disorder

One of the less discussed impacted areas of development in children with ASD is motor control. The developmental delays could affect the children’s gross and fine motor skills, such as walking and jumping, to more fine motor tasks like writing or buttoning a shirt. The goal of physiotherapy is to gather information from parents, Physiotherapy plays an important role in supporting individuals with Autism Spectrum Disorder (ASD) by addressing physical limitations and promoting overall well-being.

Improving motor skills

Physiotherapy focuses on improving motor skills, coordination, balance and gross motor skills. It focuses on specific exercises to improve muscle tone, strength and flexibility, which helps improve movement control and coordination in individuals with ASD.

Exercise based physiotherapy treatments include age-appropriate physical and motor skills, like jumping, clapping hands, skipping, hopping and throwing, kicking or catching a ball.

Promoting Physical Education and Physical Fitness to Children with ASD

Motor skills are said to form the foundation for sport-specific skills are predictive of physical activity participation and have been linked with cognitive outcomes. Furthermore, a deficit in motor skills may insist, the presence of a developmental or medical condition, requiring specialised interventions Children with ASD have poor motor performance, hence it is recommend that early intervention programs focus on motor development. Physiotherapists can stimulate the learning of functional motor skills to help the child compensate for motor skills disturbances

Sensory Integration

Many individuals with ASD experience sensory processing problems. Physiotherapy uses sensory integration techniques to help individuals manage sensory information, reduce sensory seeking and improve their ability to effectively process and respond to sensory input.

Behavioral regulation

Physical activities in physical therapy sessions can help regulate behaviours commonly associated with ASD. Exercise and activity promote relaxation, reduce stress, and help manage hyperactivity or repetitive behaviours by channelling energy into purposeful movements.

Improved quality of life

Physical therapy interventions can improve an individual’s overall quality of life by addressing physical discomfort, promoting independence in daily activities, and fostering a sense of accomplishment through reaching physical milestones.

Collaborative approach

Physiotherapists often work together as part of multidisciplinary teams made up of occupational therapists, speech therapists, educators and caregivers. This collaborative approach ensures a holistic and tailored intervention plan that takes into account the various aspects of an individual’s needs.

Long-term benefits

Consistent physical therapy interventions can lead to long-term improvements in physical abilities, contribute to increased participation in social activities, better engagement in educational settings, and improve overall health and well-being in individuals with ASD. The role of the physiotherapist is to take care of autistic children with motor impairments in the body (for instance; issues with respiratory control and coordination level, improvement in posture, and addressing misalignment in the musculoskeletal system including chest wall deformities as well as foot and ankle misalignment issues.  

 Physiotherapists are also involved with rehabilitation after injuries where a child may be injured from a fractured leg and require rehabilitation treatments. However, physiotherapists must consider the diagnosis of autism when designing treatment sessions. This is because many of the physiotherapy sessions are very structured in nature. Teaching them to be comfortable and competent in their bodies is an essential part of the treatment.

Physiotherapy session for ASD children

Exercises for ASD Children:

Here are some of the best exercises that are proven to be beneficial:

Mirror Exercises

• An individual stands with hands by the side. Face towards the therapist.
• Make small movements for the individual and pursue them to repeat the same.
• Start with small movements like moving the shoulders up and down and eventually moving towards the complex ones.
• After the warm-up session start with the real practice.
• Ask an individual to lift the right hand up while mimicking like a mirror, the therapist picks the left one.
• Repeat the same for the legs, trunk, and neck.
• Continue this exercise for a minute and repeat it 4-5 times.

Arm Circles

• An individual is asked to stand with feet shoulder-width apart. and arms resting by the side.
• Slowly extend arms by the sides at shoulder level.
• Keeping the arms straight, start making small circles with the hands.
• Slowly, start making the circles bigger and continue creating the movement.
• First, do the exercise in the clockwise direction and then in the anti-clockwise direction repeat in each direction 20 times.

Bear Crawls

• Place hands under the shoulders and knees under the hip.
• Walk forward using the four across the floor.
• Next, move backward in the same position.
• When the person becomes comfortable, progression can be done in distance, speed, and direction.

Star Jumps

• Basic locomotor exercises like running and jumping can be performed
• Stand on the floor, with knees bent slightly, and tuck the arms in towards the chest.
• After counting 3, jump up from the squatting position, extending the arms and legs wide open. Making the body look like the symbol X.
• After landing on the floor, return to the starting position and repeat it 20 times.
• For running an individual is asked to start running at low speed over shorter distances, after the patient becomes comfortable the speed of running and distance to be covered are increased

Hurdle Step-overs

• In these exercises, low hurdles are used, and the individual steps over each hurdle.
• The knees are raised high and the head is looking forward.
• If the knees turn inward or outward, the examiner can prompt the individual by tapping the knee or holding a hand next to the foot.
• Walking forwards or backward, and sideways by crossing the hurdles,

Medicine Ball Slams

• Ask the person to hold a medicine ball in hand and stand straight.
• Raise the ball over the head with the arms straight.
• Slam the ball down on the floor with full force.
• Then just bend the knees and pick the ball.
• Repeat it 20 times.

Grab Ball Complex (GBC)

• An individual stands in front of the therapist.
• Spot markers can be used.
• The therapist holds a ball at arm's length in various positions in front of the individual.
• The individual should bend, rotate, and reach to grab the object.
• One or both hands can be used in up, down, right, and left directions.

Ball Tap Complex (BTC)

• The individual holds the ball while the therapist holds out a hand or other object.
• The individual taps the hand with the ball.
• The target can be held in a variety of positions and presented in random order or a particular sequence.

Activity-oriented Exercises

To enhance the fine motor skill, tasks like

• Using a pencil.
• Cutting with scissors.
• Playing with pegs.
• Other activities like clapping hands, skipping, hopping and throwing, kicking or catching a ball, and standing on one leg.
• Horse riding.
• Bicycling.

Hydrotherapy for Children with ASD

Regarding motor skill development, physiotherapists have argued that swim instruction methods for children with ASD can lead to faster learning of these skills. Some research argued that Hydrotherapy can be a beneficial form of exercise for autistic children. In addition, exercise-based physiotherapy can be highly beneficial for children with Autism.   

Aquatherapy has been commonly used to treat Autism patients. This usually takes place in a swimming pool. The pressure and temperature of the water pressing against the body can soothe an autistic child. Water as a property form can provide a claiming sensory input while the child performs exercises designed to improve range of motion and overall mobility. Warm water can reduce body weight by 90%, decrease the force of impact on the body, relax muscles and reduce spasticity, making water the ideal medium to rehabilitate the body. 

 

Promoting Physical Fitness in Children with ASD

One of the reasons for the low participation rate in Physical Education (PE) for children with ASD (53%) and ADHD (38%) could be associated with problems in main diagnosis and associated motor impairments. Cairney et al (2005) found that children with DCD are less likely to be physically active.

It has been argued that there is a need for better-tailored (Physical Education) PE for children with neuropsychiatric disorders, promoting the development of motor skills, with a sense of self-efficacy and physical fitness. 

The United Nations Sustainable Development Goals suggested the importance of early childhood development to enable children to reach their full potential, with physical development being the top priority, and a critical component for growth. It is widely accepted that children are required to perform basic motor skills such as locomotor (running and jumping), balance (standing on one leg), object control (catching, throwing and kicking) and fine motor tasks (using a pencil and scissors) 

For example, motor skills are said to form the foundation for sport-specific skills are predictive of physical activity participation and have been linked with cognitive outcomes. Poor motor skills has also been reflected in childhood obesity, which is associated with short and long term adverse health related consequences. Furthermore, a deficit in motor skills may insist, the presence of a developmental or medical condition, requiring specialised interventions. 

Children with ASD have poor motor performance, hence it is recommended that early intervention programs focus on motor development. Physiotherapists can stimulate the learning of functional motor skills to help the child compensate for motor skills disturbances.

Importance of Physical Education and activity for ASD children

Conclusion

Physiotherapy treatments and education to Children with ASD are important due to the motor related difficulties they encounter during their developmental stage. The treatments have been successful in improving and decreasing the severity level of their weak muscle control which result in many other consequences when they grow up if left untreated.

Physiotherapists should engage in plays based therapy/exercise interventions, where they can teach the children to be confident and comfortable of their bodies.

It is also necessary to consider that the management of children with ASD is multidisciplinary, the physiotherapists are reminded to work hand in hand with other disciplines (Doctors, Occupational therapists, speech therapists, nurses, educators, etc.). This will lead to better outcome in the future for many children with ASD.